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General NPI Number Information
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NPI Number | 1427280767
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Entity Type | Organization
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Legal Business Name | MILAGRO PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 4201 CENTRAL AVE NW SUITE K-2
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-1630
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Country | US
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Telephone | 505-429-2686
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 CENTRAL AVE NW SUITE K-2
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-1630
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Country | US
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Telephone | 505-429-2686
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELIZABETH SCHEAR
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Credential |
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Telephone | 505-429-2686
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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 |
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License Number State | NM
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