1174567366 NPI number — PHYSICAL THERAPY CLINIC AT LA CUEVA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174567366 NPI number — PHYSICAL THERAPY CLINIC AT LA CUEVA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY CLINIC AT LA CUEVA
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:
1174567366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7920 CLAREMONT AVE NE
Provider Second Line Business Mailing Address:
SUITE #3
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-3712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-344-4959
Provider Business Mailing Address Fax Number:
505-341-0426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7920 CARMEL NE
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-344-4959
Provider Business Practice Location Address Fax Number:
505-341-0426
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIPPLE
Authorized Official First Name:
TRACIE
Authorized Official Middle Name:
LORIECIE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
505-344-4959

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , 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)





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