Healthcare Provider Details

I. General information

NPI: 1417115999
Provider Name (Legal Business Name): SANTA FE PHYSICAL THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W CORDOVA RD
SANTA FE NM
87505-1850
US

IV. Provider business mailing address

333 W CORDOVA RD
SANTA FE NM
87505-1850
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-9101
  • Fax: 505-984-8998
Mailing address:
  • Phone: 505-984-9101
  • Fax: 505-984-8998

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: BRUCE MAZUR
Title or Position: OWNER/PRINCIPAL
Credential: PT
Phone: 505-470-6729