Healthcare Provider Details

I. General information

NPI: 1992484810
Provider Name (Legal Business Name): OPTAH PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 ROCKWAY BLVD NE
RIO RANCHO NM
87124-4473
US

IV. Provider business mailing address

467 ROCKWAY BLVD NE
RIO RANCHO NM
87124-4473
US

V. Phone/Fax

Practice location:
  • Phone: 505-319-8564
  • Fax:
Mailing address:
  • Phone: 505-319-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAINIE GARCIA
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: MPT, MLD CERTIFIED
Phone: 505-319-8564