Healthcare Provider Details

I. General information

NPI: 1760871552
Provider Name (Legal Business Name): PAUL MURTAGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 FOREST HILLS DR NE
ALBUQUERQUE NM
87109-4129
US

IV. Provider business mailing address

8601 TIERRA BONITA PL NE
ALBUQUERQUE NM
87122-2840
US

V. Phone/Fax

Practice location:
  • Phone: 505-822-6000
  • Fax:
Mailing address:
  • Phone: 505-797-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0649
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: