Provider Demographics
NPI:1992987127
Name:CENTRO DE TERAPIA FISICA TLC
Entity type:Organization
Organization Name:CENTRO DE TERAPIA FISICA TLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-317-9342
Mailing Address - Street 1:CALLE 6 BLOQUE 6 #15 SECCION 3
Mailing Address - Street 2:DORAVILLE
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00946-5939
Mailing Address - Country:US
Mailing Address - Phone:787-317-9342
Mailing Address - Fax:
Practice Address - Street 1:S11 CALLE CASTIGLIONI
Practice Address - Street 2:BAYAMON GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2430
Practice Address - Country:US
Practice Address - Phone:787-317-9342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR887261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy