Provider Demographics
NPI:1851399273
Name:CENTRO DE TERAPIA FISICA DE LARES, INC.
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA DE LARES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL TERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIZETTE
Authorized Official - Middle Name:I
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-898-5885
Mailing Address - Street 1:REPARTO MARQUEZ
Mailing Address - Street 2:G-26 CALLE 9
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-0000
Mailing Address - Country:US
Mailing Address - Phone:787-898-5885
Mailing Address - Fax:787-898-5885
Practice Address - Street 1:CARR. 129 KM. 13.6
Practice Address - Street 2:BO. BAYANEY
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-898-5885
Practice Address - Fax:787-898-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR871261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3303349OtherACAA
PR238022OtherPREFERRED HEALTH
PR3583548OtherPLAN UIA
PR3583548OtherMMM
PR89222OtherTRIPLE-S
PR9004126OtherCRUZ AZUL
PR6400182OtherHUMANA
PR89222OtherTRIPLE-S
PR=========OtherCIGNA
PR=========OtherDEPT. OF VETERANS
PR=========OtherCOSVIMED
PR=========OtherFIRST MEDICAL CARD
PR=========OtherCRUZ AZUL
PR9004126OtherCRUZ AZUL
PR=========OtherFIRST MEDICAL CARD
PR3583548OtherPLAN UIA
PR=========OtherCRUZ AZUL
PR3583548Medicare ID - Type UnspecifiedMMM HEALTHCARE
PR6400182OtherHUMANA
PR8289Medicare ID - Type UnspecifiedAMERICAN HEALTH MEDICARE