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General NPI Number Information
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NPI Number | 1437473089
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRIC THERAPY
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 3308 OASIS SPRINGS RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-2579
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Country | US
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Telephone | 505-891-2590
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Fax | 505-892-7359
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Provider Business Mailing Address
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Address Line | 3308 OASIS SPRINGS RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-2579
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Country | US
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Telephone | 505-980-3051
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Fax | 505-892-7359
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MS. VICTORIA MARGARET HERRERA
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Credential | M.S., CCC-SLP
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Telephone | 505-891-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4246
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License Number State | NM
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