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General NPI Number Information
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NPI Number | 1770173544
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Entity Type | Organization
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Legal Business Name | BOSQUE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 227 HWY 346
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City | BOSQUE
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State | NM
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Zip | 87006
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Country | US
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Telephone | 505-450-3451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 460
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City | BOSQUE
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State | NM
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Zip | 87006-0460
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Country | US
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Telephone | 505-450-3451
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | VALERIE GUTIERREZ
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Credential | DPT
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Telephone | 505-450-3451
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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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