Provider Demographics
NPI:1649524927
Name:CENTRO JICMENET DE TERAPIA FISICA
Entity type:Organization
Organization Name:CENTRO JICMENET DE TERAPIA FISICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TERAPISTA FISICO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-867-6200
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-0250
Mailing Address - Country:US
Mailing Address - Phone:787-867-6200
Mailing Address - Fax:787-867-6200
Practice Address - Street 1:10 CALLE LUIS M ALFARO
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4410
Practice Address - Country:US
Practice Address - Phone:787-867-6200
Practice Address - Fax:787-867-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR885261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFZ477AMedicare Oscar/Certification