Healthcare Provider Details

I. General information

NPI: 1467074955
Provider Name (Legal Business Name): STRONG AGAIN PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 PRAIRIE ZINNIA DR
BERNALILLO NM
87004-5801
US

IV. Provider business mailing address

1083 PRAIRIE ZINNIA DR
BERNALILLO NM
87004-5801
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-7994
  • Fax: 505-930-7136
Mailing address:
  • Phone: 505-933-7994
  • Fax: 505-930-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARY EDGAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 480-206-6240