Healthcare Provider Details

I. General information

NPI: 1831783422
Provider Name (Legal Business Name): PASEO PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 HIGH ASSETS WAY NW
ALBUQUERQUE NM
87120-5808
US

IV. Provider business mailing address

6916 BOCA NEGRA PL NW
ALBUQUERQUE NM
87120-1359
US

V. Phone/Fax

Practice location:
  • Phone: 505-452-6407
  • Fax:
Mailing address:
  • Phone: 505-452-6407
  • 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: MICHAEL TODD ROHDE
Title or Position: OWNER
Credential: PT
Phone: 505-452-6407