Organization Name: | SW BRIAN INTEGRATION THERAPY & REHAB LLC |
NPI Number: | 1588973077 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STAR AMBER RIDSDALE (OWNER) |
Mailing Address: | 1005 21 St. Se Suite # 4 Rio Rancho |
State: | NM US |
Postal Code: | 87124 |
Phone Number: | 5052399644 |
Fax Number: | 5058962958 |
NPI Enumeration Date: | 09/30/2010 |
NPI Last Update Date: | 09/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |