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General NPI Number Information
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NPI Number | 1659154169
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Entity Type | Organization
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Legal Business Name | VIVA PHYSIOTHERAPY, LLC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1033 LAWRENCE DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1811
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Country | US
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Telephone | 575-650-7544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90113
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-0113
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Country | US
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Telephone | 575-650-7544
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED AGENT/MANAGING MEMBER
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Name | TESS M GARCIA
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Credential | PT, DPT
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Telephone | 575-650-7544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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