Provider Demographics
NPI:1912025016
Name:CENTRO DE TERAPIA FISICA Y ELECTRODIAGNOSTICO INC
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA Y ELECTRODIAGNOSTICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUCAGE GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-877-3466
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1298
Mailing Address - Country:US
Mailing Address - Phone:787-877-3466
Mailing Address - Fax:787-551-7316
Practice Address - Street 1:CALLE CONCEPCION VERA AYALA
Practice Address - Street 2:550
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0068
Practice Address - Country:US
Practice Address - Phone:787-877-3466
Practice Address - Fax:787-551-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy