Healthcare Provider Details

I. General information

NPI: 1891978987
Provider Name (Legal Business Name): SANDRA S MADDEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 CARLISLE BLVD NE STE 209
ALBUQUERQUE NM
87107-4849
US

IV. Provider business mailing address

10821 CLYBURN PARK DR NE
ALBUQUERQUE NM
87123-4887
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-0232
  • Fax: 505-823-1051
Mailing address:
  • Phone: 505-268-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number551
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: