Provider Demographics
NPI:1972696649
Name:SPINE SPORTS AND MANUAL MEDICINE CLINIC PSC
Entity type:Organization
Organization Name:SPINE SPORTS AND MANUAL MEDICINE CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-782-2436
Mailing Address - Street 1:221 CARR 2
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1915
Mailing Address - Country:US
Mailing Address - Phone:787-782-2424
Mailing Address - Fax:787-782-2430
Practice Address - Street 1:221 CARR 2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1915
Practice Address - Country:US
Practice Address - Phone:787-782-2424
Practice Address - Fax:787-782-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty