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General NPI Number Information
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NPI Number | 1518331198
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Entity Type | Organization
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Legal Business Name | WELLNESS WORKS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 404 BRUNN SCHOOL RD STE D
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City | SANTA FE
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State | NM
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Zip | 87505-1102
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Country | US
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Telephone | 505-983-0670
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Fax | 505-983-0118
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Provider Business Mailing Address
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Address Line | 404 BRUNN SCHOOL RD STE D
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City | SANTA FE
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State | NM
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Zip | 87505-1102
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Country | US
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Telephone | 505-983-0670
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Fax | 505-983-0118
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Authorized Official
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Title or Position | PT/OWNER
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Name | VIRGINIA BYRD
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Credential |
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Telephone | 505-983-0670
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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 | 2941
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License Number State | NM
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