Provider Demographics
NPI:1780123117
Name:ATHLETIC TRAINING AND REHAB CENTER LLC
Entity type:Organization
Organization Name:ATHLETIC TRAINING AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-484-9505
Mailing Address - Street 1:BH 9 CALLE QUINTANA SANTA JUANITA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4656
Mailing Address - Country:US
Mailing Address - Phone:939-264-1889
Mailing Address - Fax:787-395-7972
Practice Address - Street 1:BH 9 CALLE QUINTANA SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4656
Practice Address - Country:US
Practice Address - Phone:939-264-1889
Practice Address - Fax:787-395-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1923261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation