Provider Demographics
NPI:1578137014
Name:FC KIDS THERAPY CENTER LLC
Entity type:Organization
Organization Name:FC KIDS THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:I
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:OTA
Authorized Official - Phone:787-610-2387
Mailing Address - Street 1:HC 3 BOX 11257
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9551
Mailing Address - Country:US
Mailing Address - Phone:787-610-2387
Mailing Address - Fax:
Practice Address - Street 1:PARCELAS GUAYABAL, CALLE 6 CASA 95
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9551
Practice Address - Country:US
Practice Address - Phone:939-328-3588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty