Provider Demographics
NPI:1871926758
Name:CLINICA DE TERAPIA PROFESIONAL CSP
Entity type:Organization
Organization Name:CLINICA DE TERAPIA PROFESIONAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACOSTA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-760-8405
Mailing Address - Street 1:PO BOX 1917
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1917
Mailing Address - Country:US
Mailing Address - Phone:787-760-8405
Mailing Address - Fax:787-760-8484
Practice Address - Street 1:AVE. PERIFERAL G-10
Practice Address - Street 2:COOP. CUIDAD UNIVERSITARIA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2133
Practice Address - Country:US
Practice Address - Phone:787-760-8405
Practice Address - Fax:787-760-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy