Healthcare Provider Details

I. General information

NPI: 1114950649
Provider Name (Legal Business Name): EASI THERAPY & DIAGNOSTIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 COPPER AVE NE
ALBUQUERQUE NM
87108-1473
US

IV. Provider business mailing address

5200 COPPER AVE NE
ALBUQUERQUE NM
87108-1473
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-5099
  • Fax: 505-255-4206
Mailing address:
  • Phone: 505-255-5099
  • Fax: 505-255-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT0004990
License Number StateNM

VIII. Authorized Official

Name: RUTH LYNN MILLER
Title or Position: CAO
Credential: EDS
Phone: 505-255-5099