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General NPI Number Information
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NPI Number | 1265328363
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Entity Type | Organization
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Legal Business Name | IDEAL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 4001 E MAIN ST
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City | FARMINGTON
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State | NM
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Zip | 87402-8750
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Country | US
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Telephone | 619-890-4126
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Fax |
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Provider Business Mailing Address
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Address Line | 5107 LEE LN
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City | FARMINGTON
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State | NM
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Zip | 87402-8201
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Country | US
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Telephone | 619-890-4126
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD PHYSICAL THERAPIST
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Name | JAMES HARRIS
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Credential | PT, DPT
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Telephone | 619-890-4126
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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 |
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License Number State |
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