Healthcare Provider Details

I. General information

NPI: 1629078126
Provider Name (Legal Business Name): TURQUOISE TRAIL PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 MCLEOD RD NE
ALBUQUERQUE NM
87109-2118
US

IV. Provider business mailing address

PO BOX 29269
SANTA FE NM
87592-9269
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-2032
  • Fax: 505-837-2030
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number3125
License Number StateNM

VIII. Authorized Official

Name: MICHAEL R HOERNING
Title or Position: RPT DIRECTOR
Credential: PT
Phone: 505-984-2032