Provider Demographics
NPI:1659348118
Name:INSTITUTO DE TERAPIA FISICA, INC.
Entity Type:Organization
Organization Name:INSTITUTO DE TERAPIA FISICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-0991
Mailing Address - Street 1:PLAZA RIO HONDO
Mailing Address - Street 2:SUITE 268 2M
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3106
Mailing Address - Country:US
Mailing Address - Phone:787-780-0991
Mailing Address - Fax:787-785-0844
Practice Address - Street 1:58 CALLE PROGRESO
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3022
Practice Address - Country:US
Practice Address - Phone:787-780-0991
Practice Address - Fax:787-785-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082731Medicare ID - Type Unspecified