1780656413 NPI number — PHYSICAL THERAPY SERVICES INC

Table of content: (NPI 1780656413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780656413 NPI number — PHYSICAL THERAPY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PUERTO RICO PROSTHETICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780656413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 56
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-0056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-5055
Provider Business Mailing Address Fax Number:
787-807-2299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ATENAS MEDICAL & SHOPPING CENTER
Provider Second Line Business Practice Location Address:
URB. ATENAS SUITE 4 & 6
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-5055
Provider Business Practice Location Address Fax Number:
787-807-2299
Provider Enumeration Date:
02/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALDONADO
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-854-5055

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X , with the licence number:  C15272 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X , with the licence number: C15272 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55042 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0841050001 . This is a "MEDICARE NSC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1780656413 . This is a "PROSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".