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General NPI Number Information
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NPI Number | 1760958730
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Entity Type | Organization
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Legal Business Name | GAIN PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 17 AVENIDA CAMPO VERDE
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City | SANTA FE
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State | NM
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Zip | 87506-0269
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Country | US
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Telephone | 505-257-8288
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 184
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City | TESUQUE
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State | NM
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Zip | 87574-0184
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Country | US
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Telephone | 505-257-8288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC DOUGLAS PAYNE
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Credential | PT, DPT, OCS
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Telephone | 505-257-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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