Provider Demographics
NPI:1447283353
Name:PAIN REHABILITATION MANAGEMENT
Entity type:Organization
Organization Name:PAIN REHABILITATION MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA DE FISIOTERAPIA
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEZ GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:ANCILLIAR
Authorized Official - Phone:787-893-4200
Mailing Address - Street 1:104 FAIRWAY DR
Mailing Address - Street 2:PALMAS DEL MAR
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6021
Mailing Address - Country:US
Mailing Address - Phone:787-502-1111
Mailing Address - Fax:787-893-3272
Practice Address - Street 1:2 CALLE SATURNINO RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3532
Practice Address - Country:US
Practice Address - Phone:787-893-4200
Practice Address - Fax:787-893-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022444Medicare ID - Type Unspecified