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General NPI Number Information
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NPI Number | 1710640024
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Entity Type | Organization
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Legal Business Name | REACTIVE PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 722 S SUNSET AVE
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City | ROSWELL
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State | NM
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Zip | 88203-2800
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Country | US
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Telephone | 503-349-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 W 2ND ST
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City | ROSWELL
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State | NM
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Zip | 88201-2000
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Country | US
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Telephone | 503-349-0332
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIERSTEN LYNN
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Credential | DPT
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Telephone | 575-208-8575
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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 |
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