Provider Demographics
NPI:1740391036
Name:CENTRO DE TERAPIA FISICA CAROLINA
Entity type:Organization
Organization Name:CENTRO DE TERAPIA FISICA CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMALEK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERA CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-768-0966
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0150
Mailing Address - Country:US
Mailing Address - Phone:787-768-0966
Mailing Address - Fax:787-768-0966
Practice Address - Street 1:56 CALLE AGUSTIN CABRERA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6035
Practice Address - Country:US
Practice Address - Phone:787-768-0966
Practice Address - Fax:787-768-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN