Healthcare Provider Details

I. General information

NPI: 1023762424
Provider Name (Legal Business Name): SACRED ROOTS PELVIC HEALTH AND PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 02/05/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 4TH ST NW # E
LOS RANCHOS NM
87107-6639
US

IV. Provider business mailing address

9417 ADMIRAL LOWELL AVE NE
ALBUQUERQUE NM
87111-1201
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-3487
  • Fax:
Mailing address:
  • Phone: 505-609-3487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AMY LINK
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 505-609-3487