Healthcare Provider Details

I. General information

NPI: 1598866808
Provider Name (Legal Business Name): INDUSTRIAL REHABILITATION CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 SAN FRANCISCO RD NE
ALBUQUERQUE NM
87109-4640
US

IV. Provider business mailing address

PO BOX 91270
ALBUQUERQUE NM
87199-1270
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-7691
  • Fax:
Mailing address:
  • Phone: 505-797-7691
  • Fax: 505-797-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. ANTHONY P REEVE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 505-797-7691