Healthcare Provider Details

I. General information

NPI: 1063001881
Provider Name (Legal Business Name): NM SANTA FE PT INVESTMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR STE 501
SANTA FE NM
87505-7632
US

IV. Provider business mailing address

460 SAINT MICHAELS DR STE 501
SANTA FE NM
87505-7632
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-8783
  • Fax:
Mailing address:
  • Phone: 505-780-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE RADLEY
Title or Position: CONSULTANT
Credential:
Phone: 713-591-2256