Healthcare Provider Details

I. General information

NPI: 1255530044
Provider Name (Legal Business Name): PT FIRST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 C HARDWARE AVE SUITE 3
ALBUQUERQUE NM
87109-2021
US

IV. Provider business mailing address

4811 C HARDWARE AVE SUITE 3
ALBUQUERQUE NM
87109-2021
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-8722
  • Fax:
Mailing address:
  • Phone: 505-884-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number225100000X
License Number StateNM

VIII. Authorized Official

Name: MR. FELIPE J. MARES
Title or Position: OWNER
Credential: PT, DPT, ATC/L
Phone: 505-884-4609