Healthcare Provider Details

I. General information

NPI: 1437647492
Provider Name (Legal Business Name): FERDIRIC KING MADARANG PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-6022
US

IV. Provider business mailing address

10101 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-6022
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-1231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number4297
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: