Provider Demographics
NPI:1194048967
Name:CENTRO DE TERAPIA FISICA Y ATLETICA NUEVA VIDA PSC
Entity type:Organization
Organization Name:CENTRO DE TERAPIA FISICA Y ATLETICA NUEVA VIDA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLET SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:787-544-6888
Mailing Address - Street 1:PO BOX 141024
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1024
Mailing Address - Country:US
Mailing Address - Phone:787-544-6888
Mailing Address - Fax:787-544-6888
Practice Address - Street 1:462 ATLANTIC VIEW BUILDIN SUITE 2
Practice Address - Street 2:CARRETERA 2 KM 83.5 MARGINAL CARRIZALES
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-544-6888
Practice Address - Fax:787-544-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty