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General NPI Number Information
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NPI Number | 1285917666
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Entity Type | Individual
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Provider Name | MICHAEL SCOTT FREEMAN P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 505 ELM ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2500
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Country | US
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Telephone | 717-437-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 217 MAPLE AVE
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City | GALLUP
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State | NM
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Zip | 87301-5944
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Country | US
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Telephone | 717-437-3312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT021284
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT005831
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License Number State | KY
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