Healthcare Provider Details

I. General information

NPI: 1083947022
Provider Name (Legal Business Name): BETTINA MARIA BROWN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5019
US

IV. Provider business mailing address

7816 BURSERA DR NW
ALBUQUERQUE NM
87120-5212
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8000
  • Fax:
Mailing address:
  • Phone: 505-264-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3302
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: