Provider Demographics
NPI:1295046852
Name:TERAPIA FISICA MOVIMIENTO ES VIDA
Entity type:Organization
Organization Name:TERAPIA FISICA MOVIMIENTO ES VIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL TERAPIST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-877-1213
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:UM
Mailing Address - Phone:787-877-1213
Mailing Address - Fax:787-877-1213
Practice Address - Street 1:EDIFICIO DON PABLO CARR 110 KM 12.8
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:UM
Practice Address - Phone:787-877-1213
Practice Address - Fax:787-877-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1238251E00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1073630828OtherNPI
PR005-8705Medicare PIN