Provider Demographics
NPI:1184100760
Name:CENTRO DE TERAPIA MUSCULAR LLC
Entity type:Organization
Organization Name:CENTRO DE TERAPIA MUSCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:O
Authorized Official - Last Name:MARTINEZ LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:787-949-6590
Mailing Address - Street 1:740 AVENIDA DE HOSTOS CARRETERA 2
Mailing Address - Street 2:MEDICAL CENTER PLAZA SUITE 212
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-949-6590
Mailing Address - Fax:
Practice Address - Street 1:740 AVENIDA DE HOSTOS CARRETERA 2
Practice Address - Street 2:MEDICAL CENTER PLAZA SUITE 212
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-949-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1962905281OtherNPI