Provider Demographics
NPI:1689167223
Name:A&A THERAPY SERVICE INC
Entity Type:Organization
Organization Name:A&A THERAPY SERVICE INC
Other - Org Name:A&A THERAPY SERVICE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:OTL
Authorized Official - Phone:787-461-8284
Mailing Address - Street 1:F3 SAN JORGE
Mailing Address - Street 2:URB VILLA DEL PILAR
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735
Mailing Address - Country:US
Mailing Address - Phone:787-461-8284
Mailing Address - Fax:
Practice Address - Street 1:F3 SAN JORGE
Practice Address - Street 2:URB VILLA DEL PILAR
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:787-461-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNIE AGOSTO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-08
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1861624454Medicaid
PR=========Medicaid