Provider Demographics
NPI:1457742322
Name:CENTRO DE TERAPIA FISICA RENACE
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA RENACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARYNELI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-454-7888
Mailing Address - Street 1:2410 CALLE GOLONDRINA
Mailing Address - Street 2:COMUNIDAD CAPIRO
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4526
Mailing Address - Country:US
Mailing Address - Phone:787-454-7888
Mailing Address - Fax:787-872-3232
Practice Address - Street 1:3623 AVE. MILITAR ISABELA
Practice Address - Street 2:ISABELA PROFESSIONAL BUILDING, SUITE 102
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-454-7888
Practice Address - Fax:787-872-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation