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General NPI Number Information
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NPI Number | 1083288633
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Entity Type | Organization
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Legal Business Name | VISTA LINDA REHABILITATION LLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 35 BUENA VISTA RD
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City | EL PRADO
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State | NM
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Zip | 87529
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Country | US
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Telephone | 575-613-2850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2841
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City | TAOS
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State | NM
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Zip | 87571-2841
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Country | US
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Telephone | 575-613-2850
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SOPHIA SEIM
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Credential | DPT
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Telephone | 575-613-2850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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