Provider Demographics
NPI:1669739595
Name:CENTRO DE TERAPIA FISICA BOAZ VEGA BAJA
Entity type:Organization
Organization Name:CENTRO DE TERAPIA FISICA BOAZ VEGA BAJA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OTERO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-858-4845
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:GARROCHALES
Mailing Address - State:PR
Mailing Address - Zip Code:00652-0558
Mailing Address - Country:US
Mailing Address - Phone:787-858-4845
Mailing Address - Fax:787-858-4845
Practice Address - Street 1:CARR. # 2 KM. 39.9
Practice Address - Street 2:PLAZA JARDINES SUITE # 2
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-4845
Practice Address - Fax:787-858-4845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE TERAPIA FISICA BOAZ ARECIBO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR797261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRS32047Medicare UPIN
PR88603Medicare PIN