Organization
PROHEALTH THERAPY & SPORTS REHAB, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENIFFER MARI VAZQUEZ (PHYSICAL THERAPIST)
(787) 313-0829
Entity
Organization
Contact information
Practice address
BO GUAYABO CARR 115, KM 20.6, AGUADA, PR 00602-9305
(787) 313-0829
Mailing address
HC 03 BOX 29780, AGUADA, PR 00602-9305
(787) 313-0829
(787) 200-8030
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
1374
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053516252
INDIVIDUAL NPI
PR
01
—
1374
PROVIDER LICENSE
PR
Enumeration date
04/27/2012
Last updated
08/13/2012
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