Healthcare Provider Details

I. General information

NPI: 1023076197
Provider Name (Legal Business Name): PHYSICAL THERAPY PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CENTRAL AVE STE 105
LOS ALAMOS NM
87544
US

IV. Provider business mailing address

1350 CENTRAL AVE STE 105
LOS ALAMOS NM
87544
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-3384
  • Fax: 505-661-0085
Mailing address:
  • Phone: 505-662-3384
  • Fax: 505-661-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number833
License Number StateNM

VIII. Authorized Official

Name: ANNETTE WEYRAUCH
Title or Position: PRESIDENT
Credential: MSPT
Phone: 505-662-3384