Provider Demographics
NPI:1821212978
Name:ELOI PHYSICAL THERAPY PSC
Entity Type:Organization
Organization Name:ELOI PHYSICAL THERAPY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:VAZQUEZ
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-466-9466
Mailing Address - Street 1:PO BOX 2083
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9083
Mailing Address - Country:US
Mailing Address - Phone:787-466-9466
Mailing Address - Fax:787-822-0710
Practice Address - Street 1:39 CALLE RAMON TORRES
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-2040
Practice Address - Country:US
Practice Address - Phone:787-466-9466
Practice Address - Fax:787-822-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1216261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy