Provider Demographics
NPI:1215354261
Name:CLINICA TERAPIA FISICA ISLA VERDE
Entity type:Organization
Organization Name:CLINICA TERAPIA FISICA ISLA VERDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACOSTA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-253-0396
Mailing Address - Street 1:PO BOX 1917
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1917
Mailing Address - Country:US
Mailing Address - Phone:787-253-0396
Mailing Address - Fax:787-191-5104
Practice Address - Street 1:AVE LAGUNA
Practice Address - Street 2:SUITE 116
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6525
Practice Address - Country:US
Practice Address - Phone:787-253-0396
Practice Address - Fax:787-791-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy