Healthcare Provider Details

I. General information

NPI: 1790440378
Provider Name (Legal Business Name): NEW MEXICO FUNCTIONL INTEGRATIVE THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 CORRALES RD
CORRALES NM
87048-9130
US

IV. Provider business mailing address

222 ANDREWS LN
CORRALES NM
87048-7453
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-1793
  • Fax:
Mailing address:
  • Phone: 505-379-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HOBBS
Title or Position: PRESIDENT
Credential: MPH, OTR/L
Phone: 505-379-1793