Healthcare Provider Details

I. General information

NPI: 1831242999
Provider Name (Legal Business Name): NEW MEXICO SPORTS & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR SUITE 220
SANTA FE NM
87505-4728
US

IV. Provider business mailing address

2954 RODEO PARK DR. WEST
SANTA FE NM
87505-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-0131
  • Fax: 505-795-7073
Mailing address:
  • Phone: 505-424-0131
  • Fax: 505-795-7032

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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6292
License Number StateNM

VIII. Authorized Official

Name: DINO J PINO
Title or Position: DIRECTOR
Credential:
Phone: 505-424-0131