Healthcare Provider Details

I. General information

NPI: 1114282340
Provider Name (Legal Business Name): PHYSICAL THERAPY AT DAWN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW SUITE 150
ALBUQUERQUE NM
87120-2681
US

IV. Provider business mailing address

600 CENTRAL AVE SE SUITE D
ALBUQUERQUE NM
87102-3656
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-2294
  • Fax: 505-242-2917
Mailing address:
  • Phone: 505-242-2294
  • Fax: 505-242-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNM

VIII. Authorized Official

Name: JOHN DENNIS
Title or Position: PRESIDENT
Credential: PT
Phone: 505-242-2294