Healthcare Provider Details

I. General information

NPI: 1639876253
Provider Name (Legal Business Name): ROBERT M. KAMB PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 MENAUL BLVD NE STE A
ALBUQUERQUE NM
87112-2262
US

IV. Provider business mailing address

1941 ROANOKE DR NE
RIO RANCHO NM
87144-5535
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-4784
  • Fax:
Mailing address:
  • Phone: 505-401-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT-2023-0018
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: