1538865043 NPI number — METHOD PHYSICAL THERAPY, LLC

Table of content: (NPI 1538865043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538865043 NPI number — METHOD PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHOD 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:
1538865043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 TULANE DR SE
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:
87106-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-615-9381
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3538 ANDERSON AVE SE
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:
87106-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-615-9381
Provider Business Practice Location Address Fax Number:
505-431-3170
Provider Enumeration Date:
02/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
QUINTAL CALVA
Authorized Official First Name:
NORA
Authorized Official Middle Name:
JACKELINE
Authorized Official Title or Position:
PHYSICAL THERAPIST AND CO-OWNER
Authorized Official Telephone Number:
505-250-8401

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1174992689 . This is a "NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com