Organization Name: | JEMEZ PHYSICAL THERAPY, PC |
NPI Number: | 1295778470 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LORRAINE L GARDNER (PRESIDENT) |
Mailing Address: | 2101 Trinity Dr Ste N Los Alamos |
State: | NM US |
Postal Code: | 875444103 |
Phone Number: | 5056616191 |
Fax Number: | 5056630386 |
NPI Enumeration Date: | 06/14/2006 |
NPI Last Update Date: | 10/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |