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General NPI Number Information
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NPI Number | 1356668990
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Entity Type | Organization
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Legal Business Name | FOUR POINT THERAPY, LLC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 173 EL CAMINO CAMPO
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City | CORRALES
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State | NM
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Zip | 87048-7518
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Country | US
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Telephone | 505-890-4117
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Fax | 505-890-8345
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Provider Business Mailing Address
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Address Line | 173 EL CAMINO CAMPO
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City | CORRALES
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State | NM
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Zip | 87048-7518
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Country | US
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Telephone | 505-890-4117
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Fax | 505-890-8345
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | MRS. DEBORA A LANPHERE
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Credential |
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Telephone | 505-710-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1591
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1591
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License Number State | NM
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