Healthcare Provider Details

I. General information

NPI: 1861772972
Provider Name (Legal Business Name): A-Z THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNSER BLVD SE STE 9
RIO RANCHO NM
87124-6370
US

IV. Provider business mailing address

701 UNSER BLVD SE STE 9
RIO RANCHO NM
87124-6370
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-7733
  • Fax: 505-892-9341
Mailing address:
  • Phone: 505-892-7733
  • Fax: 505-892-9341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number2126
License Number StateNM

VIII. Authorized Official

Name: ANTHONY GUSTAMANTES
Title or Position: DIRECTOR
Credential: MOTR/L
Phone: 505-573-8105