Provider Demographics
NPI:1982928438
Name:PHYSICS REHAB TEAM, PSC
Entity Type:Organization
Organization Name:PHYSICS REHAB TEAM, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORREA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:787-617-6671
Mailing Address - Street 1:1051 CALLE DE VALENCIA
Mailing Address - Street 2:URB PALACIOS DE MARBELLA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5213
Mailing Address - Country:US
Mailing Address - Phone:787-617-6671
Mailing Address - Fax:787-797-4128
Practice Address - Street 1:1051 CALLE DE VALENCIA
Practice Address - Street 2:URB PALACIOS DE MARBELLA
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-5213
Practice Address - Country:US
Practice Address - Phone:787-617-6671
Practice Address - Fax:787-797-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001346320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities