1316485352 NPI number — LEVEL PHYSICAL THERAPY LLC

Table of content: TRACI MAE HEESE APRN (NPI 1598747578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316485352 NPI number — LEVEL PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVEL 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:
1316485352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 GIRARD BLVD NE
Provider Second Line Business Mailing Address:
STE L
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-750-3033
Provider Business Mailing Address Fax Number:
505-738-0360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 GIRARD BLVD NE
Provider Second Line Business Practice Location Address:
STE L
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-750-3033
Provider Business Practice Location Address Fax Number:
505-738-0360
Provider Enumeration Date:
02/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VALDEZ
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CO-OWNER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
505-750-3033

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  4210 , 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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