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General NPI Number Information
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NPI Number | 1477866523
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Entity Type | Organization
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Legal Business Name | WHOLISTIC PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 117 ELM CT SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-8213
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Country | US
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Telephone | 505-891-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 117 ELM CT SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-8213
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Country | US
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Telephone | 505-891-4505
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KIM BUTTERS
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Credential | P.T.
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Telephone | 505-891-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1217
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License Number State | NM
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