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General NPI Number Information
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NPI Number | 1215157664
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | HC69 BOX 2956 288 NM HWY 276
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City | ROCIADA
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State | NM
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Zip | 87742-9709
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Country | US
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Telephone | 505-454-8880
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Fax | 505-454-8580
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Provider Business Mailing Address
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Address Line | HC69 BOX 2956 288 NM HWY 276
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City | ROCIADA
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State | NM
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Zip | 87742-9709
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Country | US
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Telephone | 505-454-8880
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Fax | 505-454-8580
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Authorized Official
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Title or Position | MEMBER OWNER
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Name | MRS. AMANDA J HERRERA
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Credential | PT, MA
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Telephone | 505-454-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3205
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License Number State | NM
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