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General NPI Number Information
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NPI Number | 1285943787
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Entity Type | Organization
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Legal Business Name | NEW MEXICO PHYSICAL THERAPISTS DBA VIBRANTCARE
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 2211C MAIN ST SE
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City | LOS LUNAS
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State | NM
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Zip | 87031-8297
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Country | US
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Telephone | 505-866-1677
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Fax | 505-866-1767
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Provider Business Mailing Address
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Address Line | 2270 DOUGLAS BLVD STE 112
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City | ROSEVILLE
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State | CA
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Zip | 95661-4239
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Country | US
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Telephone | 800-421-1965
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Fax | 916-773-1481
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Authorized Official
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Title or Position | HR
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Name | JENNIFER NICHOLSON
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Credential |
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Telephone | 800-421-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3896
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License Number State | NM
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