1811074958 NPI number — TERAPIA FISICA ELMAR INC.

Table of content: (NPI 1811074958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811074958 NPI number — TERAPIA FISICA ELMAR INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERAPIA FISICA ELMAR 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:
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:
1811074958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-4036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-975-7441
Provider Business Mailing Address Fax Number:
787-881-5572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAR 2 KM 62.8 SECTOR CANDELARIA
Provider Second Line Business Practice Location Address:
BO SABANA HOYOS
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-975-7441
Provider Business Practice Location Address Fax Number:
787-881-5572
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VENDRELL
Authorized Official First Name:
EMMANUELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-224-4185

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  153107 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811074958 . This is a "THERAPY NETWORK PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: B050 . This is a "INTERNATIONAL MEDICAL CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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