Provider Demographics
NPI:1336359751
Name:CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA SAN SEBASTIAN
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA SAN SEBASTIAN
Other - Org Name:IDALYSA MORALES RAMOS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IDALYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-896-2335
Mailing Address - Street 1:URB EL RETIRO CALLE 2 C-5
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-896-2335
Mailing Address - Fax:787-896-2335
Practice Address - Street 1:CALLE JOSE MENDEZ CARDONA #3
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-896-2335
Practice Address - Fax:787-896-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1168261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$OtherSSN
PR1023049665OtherNPI INDIVIDUO
PR597263232OtherSSN