Healthcare Provider Details

I. General information

NPI: 1447816558
Provider Name (Legal Business Name): FLETCHER PHYSICAL THERAPY AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 ROSEMONT AVE NE
ALBUQUERQUE NM
87102-1522
US

IV. Provider business mailing address

312 ROSEMONT AVE NE
ALBUQUERQUE NM
87102-1522
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-4334
  • Fax:
Mailing address:
  • Phone: 505-577-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMY FLETCHER
Title or Position: CEO
Credential: DPT
Phone: 505-577-4334