1508111311 NPI number — N'JOY PHYSICAL THERAPY,LLC

Table of content: DR. ROBERT WINSTON KEKOA SMITH N.D. (NPI 1841632627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508111311 NPI number — N'JOY PHYSICAL THERAPY,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N'JOY PHYSICAL THERAPY,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508111311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2632
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88004-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-312-6223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 N ROADRUNNER PKWY
Provider Second Line Business Practice Location Address:
303
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-7019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-312-6223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIRTON
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
575-312-6223

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2678 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)