Healthcare Provider Details

I. General information

NPI: 1689724551
Provider Name (Legal Business Name): COMMUNICATION MOBILITY INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 CARLISLE BLVD NE SUITE 209
ALBUQUERQUE NM
87107-4856
US

IV. Provider business mailing address

4308 CARLISLE BLVD NE SUITE 209
ALBUQUERQUE NM
87107-4856
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-0232
  • Fax: 505-823-1051
Mailing address:
  • Phone: 505-828-0232
  • Fax: 505-823-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2579
License Number StateNM

VIII. Authorized Official

Name: ROBERT JEREMY MARTIN
Title or Position: PRESIDENT
Credential:
Phone: 505-828-0232