Provider Demographics
NPI:1750914008
Name:SHAPES PR LLC
Entity type:Organization
Organization Name:SHAPES PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ AQINO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:787-908-0908
Mailing Address - Street 1:AVE. ARCADIO ESTRADA 4160
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0000
Mailing Address - Country:US
Mailing Address - Phone:787-908-0908
Mailing Address - Fax:
Practice Address - Street 1:AVE. ARCADIO ESTRADA 4160
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0000
Practice Address - Country:US
Practice Address - Phone:787-908-0908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAPES PR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty