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General NPI Number Information
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NPI Number | 1366847725
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Entity Type | Organization
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Legal Business Name | LIVING WATERS PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 955 RANCHERO RD
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City | BOSQUE FARMS
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State | NM
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Zip | 87068-9123
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Country | US
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Telephone | 505-369-8447
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Fax |
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Provider Business Mailing Address
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Address Line | 955 RANCHERO RD
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City | BOSQUE FARMS
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State | NM
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Zip | 87068-9123
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Country | US
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Telephone | 505-369-8447
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ OWNER
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Name | JUDITH PATRICIA BARRETT
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Credential | PT
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Telephone | 505-369-8447
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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 | 3824
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License Number State | NM
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