Healthcare Provider Details

I. General information

NPI: 1245030345
Provider Name (Legal Business Name): SF BNPT ACQUISITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 MCKENZIE ST
SANTA FE NM
87501-1883
US

IV. Provider business mailing address

940 S KIMBALL AVE STE 175
SOUTHLAKE TX
76092-9024
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-4995
  • Fax:
Mailing address:
  • Phone:
  • 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: MEMBER
Credential:
Phone: 713-591-2256