Healthcare Provider Details

I. General information

NPI: 1689521064
Provider Name (Legal Business Name): OUROAXIS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MANTANO PLAZA DR NW APT 26D
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

6000 MANTANO PLAZA DR NW APT 26D
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-4035
  • Fax:
Mailing address:
  • Phone: 505-379-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ISAAC PENNER
Title or Position: OWNER
Credential: MA, LPCC
Phone: 505-379-4035