| Prohealth Therapy & Sports Rehab, Psc | |
|
Bo Guayabo Carr 115 Km 20.6 Aguada PR 00602-9305 | |
| (787) 313-0829 | |
| Not Available |
| Full Name | Prohealth Therapy & Sports Rehab, Psc |
|---|---|
| Speciality | Clinic/Center |
| Location | Bo Guayabo Carr 115, Aguada, Puerto Rico |
| Authorized Official Name and Position | Jeniffer Mari Vazquez (PHYSICAL THERAPIST) |
| Authorized Official Contact | 7873130829 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prohealth Therapy & Sports Rehab, Psc Hc 03 Box 29780 Aguada PR 00602-9305 Ph: (787) 313-0829 | Prohealth Therapy & Sports Rehab, Psc Bo Guayabo Carr 115 Km 20.6 Aguada PR 00602-9305 Ph: (787) 313-0829 |
| NPI Number | 1578821542 |
|---|---|
| Provider Enumeration Date | 04/27/2012 |
| Last Update Date | 08/13/2012 |
| Medicare PECOS PAC ID | 3375798911 |
|---|---|
| Medicare Enrollment ID | O20130305000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578821542 | NPI | - | NPPES |
| 1374 | Other | PR | PROVIDER LICENSE |
| 1053516252 | Other | PR | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 1374 (Puerto Rico) | Primary |
| Provider Name | Jeniffer Vazquez Gonzalez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053516252 PECOS PAC ID: 2860573433 Enrollment ID: I20080122000124 |
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