Provider Demographics
NPI:1740581131
Name:PHYSIOHOME INC
Entity Type:Organization
Organization Name:PHYSIOHOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARILIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:787-944-6826
Mailing Address - Street 1:HACIENDA EL PILAR 2002
Mailing Address - Street 2:REYNA MORA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9421
Mailing Address - Country:US
Mailing Address - Phone:787-944-6826
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA EL PILAR 2002
Practice Address - Street 2:REYNA MORA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-9421
Practice Address - Country:US
Practice Address - Phone:787-944-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty