Provider Demographics
NPI:1104039841
Name:CENTRO TERAPIA FISICA REXVILLE, INC
Entity type:Organization
Organization Name:CENTRO TERAPIA FISICA REXVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:I
Authorized Official - Last Name:JIMENEZ-MONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-306-3229
Mailing Address - Street 1:RR 4 BOX 26936
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BC7 CALLE 33
Practice Address - Street 2:REXVILLE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4144
Practice Address - Country:US
Practice Address - Phone:787-306-3229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR562261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR223230OtherPREFERRED HEALTH
PR223230OtherUTI
PRP611OtherINT MEDICAL CARD
PR4141OtherAMERICAN HEALTH
PR0=========OtherCIGNA
PR4141OtherAMERICAN HEALTH
PR0=========OtherCIGNA