Healthcare Provider Details

I. General information

NPI: 1275269854
Provider Name (Legal Business Name): JOANNA BEETS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 PATO RD NW
ALBUQUERQUE NM
87120-7007
US

IV. Provider business mailing address

6516 PATO RD NW
ALBUQUERQUE NM
87120-7007
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-0656
  • Fax:
Mailing address:
  • Phone: 505-239-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: