Provider Demographics
NPI:1760779318
Name:CLINICA PEDIATRICA DE TEREPIA, INC.
Entity Type:Organization
Organization Name:CLINICA PEDIATRICA DE TEREPIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MPT, NDTC
Authorized Official - Phone:787-783-6290
Mailing Address - Street 1:URB. LA RIVIERA SE 54
Mailing Address - Street 2:1283
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-783-6290
Mailing Address - Fax:787-782-0670
Practice Address - Street 1:URB. LA RIVIERA S.E. 54
Practice Address - Street 2:1283
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3144
Practice Address - Country:US
Practice Address - Phone:787-783-6290
Practice Address - Fax:787-782-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6112251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty