Healthcare Provider Details

I. General information

NPI: 1124796297
Provider Name (Legal Business Name): AMENDA BARNES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-3221
US

IV. Provider business mailing address

1104 SALAMANCA ST NW
LOS RANCHOS NM
87107-5626
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-0717
  • Fax:
Mailing address:
  • Phone: 505-908-0717
  • Fax: 505-608-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5122
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: