Provider Demographics
NPI:1609985621
Name:LUZ C BUTLER MOYA
Entity type:Organization
Organization Name:LUZ C BUTLER MOYA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUTLER MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MS TERAPIA FISICA
Authorized Official - Phone:787-846-4121
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0430
Mailing Address - Country:US
Mailing Address - Phone:787-846-4121
Mailing Address - Fax:787-846-5661
Practice Address - Street 1:CARR #2 KM 55.2
Practice Address - Street 2:BO PALENQUE
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-895-4633
Practice Address - Fax:787-895-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50015AOtherPMC
6400239OtherHUMANA
PR870027OtherMMM
6400239OtherHUMANA