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General NPI Number Information
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NPI Number | 1376648733
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Entity Type | Organization
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Legal Business Name | SPECIAL K FITNESS, INC.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 3180 N. BUTLER AVE. BLDG. 300
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-326-2460
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Fax | 505-325-1943
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Provider Business Mailing Address
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Address Line | 3180 N. BUTLER AVE. BLDG. 300
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-326-2460
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Fax | 505-325-1943
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | KIM NOYES
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Credential | P.T.
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Telephone | 505-326-2460
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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 | 1146
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License Number State | NM
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