Healthcare Provider Details

I. General information

NPI: 1346276508
Provider Name (Legal Business Name): SOUTHWEST ORTHOPAEDIC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5067
US

IV. Provider business mailing address

1334 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5067
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-3317
  • Fax: 505-292-3402
Mailing address:
  • Phone: 505-292-3317
  • Fax: 505-292-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. KALE ROSS ISAACSON
Title or Position: MANAGING MEMBER LLC/OWNER
Credential:
Phone: 505-292-3317