Healthcare Provider Details

I. General information

NPI: 1154606655
Provider Name (Legal Business Name): ALBERT ANTHONY ARMITAGE JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 371 RTE 9 JUNCTION
CROWNPOINT NM
87313
US

IV. Provider business mailing address

PO BOX 358
CROWNPOINT NM
87313-0358
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-6291
  • Fax: 505-786-6440
Mailing address:
  • Phone: 617-291-1798
  • Fax: 505-786-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16432
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: