# REHABIBILITACION PONCE DE LEON CLINICA DE TERAPIA FISICA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417942640
- **Authorized official:** MR. EDGARDO ACOSTA SR. (ADMINISTRDOR)
- **Authorized official phone:** (787) 856-5272

## Contact information

- **Practice address:** 42 CALLE MATTEI LLUBERAS, SUITE 1, YAUCO, PR 00698-3630
- **Practice address phone:** (787) 856-5272
- **Practice address fax:** (787) 856-8421
- **Mailing address:** 42 CALLE MATTEI LLUBERAS, SUITE 1, YAUCO, PR 00698-3630
- **Mailing address phone:** (787) 856-5272
- **Mailing address fax:** (787) 856-8421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 0731 | PR | Yes |

## Other

- **Enumeration date:** 09/14/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0084104 | TRIPLE S | PR |