Healthcare Provider Details

I. General information

NPI: 1316974017
Provider Name (Legal Business Name): SPRINT SPORTS REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E COLLEGE BLVD
ROSWELL NM
88201-5158
US

IV. Provider business mailing address

113 E COLLEGE BLVD
ROSWELL NM
88201-5158
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-6500
  • Fax: 575-622-9777
Mailing address:
  • Phone: 575-622-6500
  • Fax: 575-622-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HELEN M PRITCHARD
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 575-622-6500