Provider Demographics
NPI:1891182499
Name:PROFESSIONAL THERAPY & HEALTH SERVICES, PSC
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPY & HEALTH SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:787-785-9282
Mailing Address - Street 1:COND MAGNOLIA GDNS
Mailing Address - Street 2:P-12
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-7100
Mailing Address - Country:US
Mailing Address - Phone:787-785-9282
Mailing Address - Fax:787-200-0482
Practice Address - Street 1:COND MAGNOLIA GDNS
Practice Address - Street 2:P-12
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-7100
Practice Address - Country:US
Practice Address - Phone:787-785-9282
Practice Address - Fax:787-200-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR128421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty