Healthcare Provider Details

I. General information

NPI: 1356739981
Provider Name (Legal Business Name): PHILIP TOUPS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5201
US

IV. Provider business mailing address

PO BOX 341 85 CAMINO DEL OSO
PLACITAS NM
87043-0341
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-7986
  • Fax:
Mailing address:
  • Phone: 575-312-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0954
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: