1922153733 NPI number — THINK BACK INC

Table of content: (NPI 1922153733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922153733 NPI number — THINK BACK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THINK BACK INC
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:
1922153733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87192-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-883-7518
Provider Business Mailing Address Fax Number:
505-883-8653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2516 VERMONT ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-883-7518
Provider Business Practice Location Address Fax Number:
505-883-8653
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
505-883-7518

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  331 , 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)

  • Identifier: 51453282 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com