| NPI | 1457042061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY STALLSWORTH Co Owner 505-526-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |