1386464600 NPI number — CLINICA DE TERAPIA FISICA Y REHABILITACION GENESIS LLC

Table of content: (NPI 1386464600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386464600 NPI number — CLINICA DE TERAPIA FISICA Y REHABILITACION GENESIS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE TERAPIA FISICA Y REHABILITACION GENESIS LLC
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:
Provider Other Organization Name Type Code:
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:
1386464600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEBRADILLAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00678-0980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-895-4633
Provider Business Mailing Address Fax Number:
787-895-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR #2 KM 100 BO CACAO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEBRADILLAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00678-0980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-895-4633
Provider Business Practice Location Address Fax Number:
787-895-4490
Provider Enumeration Date:
10/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER MOYA
Authorized Official First Name:
LUZ
Authorized Official Middle Name:
C
Authorized Official Title or Position:
TERAPISTA FISICO
Authorized Official Telephone Number:
787-895-4633

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1609985621 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346245032 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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