Organization
BALANCE AND VESTIBULAR REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIMARIS FUENTES DPT (PRESIDENT)
(787) 552-9757
Entity
Organization
Contact information
Practice address
CARR. 8860 KM 1.5, PLAZA MATIENZO, TRUJILLO ALTO, PR 00976-6426
(787) 552-9757
Mailing address
L26 CALLE 14, EL CONQUISTADOR, TRUJILLO ALTO, PR 00976-6426
(787) 552-9757
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1431
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511526117516-001
CCN MEDICARE
PR
Enumeration date
05/18/2016
Last updated
08/03/2016
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