Provider Demographics
NPI:1962054395
Name:PHYSICS REHAB CENTER
Entity type:Organization
Organization Name:PHYSICS REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:GOMEZ
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-288-0808
Mailing Address - Street 1:B38 CALLE NORTH VIEW COURT
Mailing Address - Street 2:URB BALDWIN PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-288-0808
Mailing Address - Fax:787-288-0888
Practice Address - Street 1:ID14 CALLE ALMACIGO
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3104
Practice Address - Country:US
Practice Address - Phone:787-288-0808
Practice Address - Fax:787-288-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1190013-0010Medicaid