Healthcare Provider Details

I. General information

NPI: 1891306932
Provider Name (Legal Business Name): RYAN LOUIS FRESQUEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3493
US

IV. Provider business mailing address

6100 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3493
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-4555
  • Fax: 505-508-1406
Mailing address:
  • Phone: 505-948-4555
  • Fax: 505-508-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5754
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: