Healthcare Provider Details

I. General information

NPI: 1386943041
Provider Name (Legal Business Name): GIANT STRIDES THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 GETTYSBURG RD NE
ALBUQUERQUE NM
87109-5021
US

IV. Provider business mailing address

7111 GETTYSBURG RD NE
ALBUQUERQUE NM
87109-5021
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-3197
  • Fax:
Mailing address:
  • Phone: 505-328-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number600
License Number StateNM

VIII. Authorized Official

Name: REBECCA MAIDMENT
Title or Position: MANAGER
Credential:
Phone: 505-328-3197