Healthcare Provider Details

I. General information

NPI: 1205227592
Provider Name (Legal Business Name): ELISABETH MAGGIO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4656
  • Fax: 505-242-4657
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1445
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: