Healthcare Provider Details

I. General information

NPI: 1952307274
Provider Name (Legal Business Name): SOUTHWEST THERAPISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S IRON ST
DEMING NM
88030-3628
US

IV. Provider business mailing address

2270 DOUGLAS BLVD STE 112
ROSEVILLE CA
95661-3869
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-2649
  • Fax: 505-546-2949
Mailing address:
  • Phone: 916-782-1212
  • Fax: 916-773-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. DAVID SMITH
Title or Position: CEO
Credential:
Phone: 916-782-1212