Healthcare Provider Details

I. General information

NPI: 1205836210
Provider Name (Legal Business Name): FRANK VERNON HATCH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 OLD PECOS TRL STE H
SANTA FE NM
87505-4760
US

IV. Provider business mailing address

1850 OLD PECOS TRL STE H
SANTA FE NM
87505-4760
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-2673
  • Fax: 505-832-3321
Mailing address:
  • Phone: 505-983-2673
  • Fax: 505-832-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1833
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: