Provider Demographics
NPI:1700209970
Name:PROREHAB WELLNESS CENTER PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PROREHAB WELLNESS CENTER PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:787-398-8246
Mailing Address - Street 1:521 AVE BALTAZAR JIMENEZ
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2157
Mailing Address - Country:US
Mailing Address - Phone:787-398-8246
Mailing Address - Fax:787-933-1586
Practice Address - Street 1:521 AVE BALTAZAR JIMENEZ
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2157
Practice Address - Country:US
Practice Address - Phone:787-398-8246
Practice Address - Fax:787-933-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty