| NPI | 1104366533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISA RODDY Owner 505-363-9582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NM 4196) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NM 4197) |
| Enumeration Date | 2017-03-04 |
| Last Update Date | 2019-11-30 |