Healthcare Provider Details

I. General information

NPI: 1699859868
Provider Name (Legal Business Name): E6 PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4479
US

IV. Provider business mailing address

3870 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4479
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-3678
  • Fax: 505-830-6505
Mailing address:
  • Phone: 505-830-3678
  • Fax: 505-830-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2523
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2523
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2523
License Number StateNM

VIII. Authorized Official

Name: MR. TED J ESPARZA
Title or Position: OWNER
Credential: PT
Phone: 505-830-3678