Healthcare Provider Details

I. General information

NPI: 1578105433
Provider Name (Legal Business Name): PTP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CENTRAL AVE STE 105
LOS ALAMOS NM
87544-6217
US

IV. Provider business mailing address

1350 CENTRAL AVE STE 105
LOS ALAMOS NM
87544-6217
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-3384
  • Fax: 505-661-0084
Mailing address:
  • Phone: 505-662-3384
  • Fax: 505-661-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PETRA PIRC
Title or Position: PRESIDENT
Credential: MSPT
Phone: 505-412-7735