Provider Demographics
NPI:1568462117
Name:FISIOTERAPIA EN LA MONTANA
Entity type:Organization
Organization Name:FISIOTERAPIA EN LA MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:787-862-7548
Mailing Address - Street 1:URB PARQUE CENTRAL EDIF MEDICO
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-772-7731
Mailing Address - Fax:
Practice Address - Street 1:URB PARQUE CENTRAL EDIF MEDICO 401
Practice Address - Street 2:SUITE 5A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-862-7548
Practice Address - Fax:787-862-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11945320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083554Medicare ID - Type UnspecifiedPROVIDER ID