Provider Demographics
NPI:1700048956
Name:EAST PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EAST PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-617-2984
Mailing Address - Street 1:HC 2 BOX 3906
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-9817
Mailing Address - Country:US
Mailing Address - Phone:787-617-2984
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 3906
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-9817
Practice Address - Country:US
Practice Address - Phone:787-617-2984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1312320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities