Provider Demographics
NPI:1023076288
Name:CENTRO DE TERAPIA FISICA Y CLINICA DEL DOLOR, CSP
Entity type:Organization
Organization Name:CENTRO DE TERAPIA FISICA Y CLINICA DEL DOLOR, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENTA ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESPERANZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:RPTA
Authorized Official - Phone:787-714-0510
Mailing Address - Street 1:4 AVENIDA JF KENNEDY
Mailing Address - Street 2:URBANIZACION FERNANDEZ
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-714-0510
Mailing Address - Fax:787-714-0185
Practice Address - Street 1:4 AVENIDA JF KENNEDY
Practice Address - Street 2:URBANIZACION FERNANDEZ
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-0510
Practice Address - Fax:787-714-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
223205OtherPREFERRED UTI
6400208OtherHUMANA REFORMA
870044OtherMMM
04232OtherAMERICAN HEALTH
79809OtherCFSE
584576598OtherGIGNA PREFERRED EXCLUSIVE
4177OtherFIRST MEDICAL
60565208OtherFIRST PLUS
M000409OtherMEN
6400208OtherHUMANA INSURANCE
3303543OtherACAA
79809OtherCFSE
870044OtherMMM
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=========OtherMCS CLASSICCARE