Provider Demographics
NPI:1982976536
Name:PHYSIOTHERAPY REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY REHABILITATION SERVICES, INC
Other - Org Name:CENTRO DE BALANCE Y VESTIBULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOREY CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:787-787-8669
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0444
Mailing Address - Country:US
Mailing Address - Phone:787-787-8669
Mailing Address - Fax:787-786-7865
Practice Address - Street 1:URB SANTA JUANITA
Practice Address - Street 2:UU43 CALLE 30
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4701
Practice Address - Country:US
Practice Address - Phone:787-787-8669
Practice Address - Fax:787-786-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-29
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X, 225100000X
PR406504261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039153000Medicaid