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General NPI Number Information
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NPI Number | 1801283452
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Entity Type | Organization
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Legal Business Name | MOVEMENT AND PERFORMANCE OF NEW MEXICO
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 1612 RIDGECREST DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-4437
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Country | US
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Telephone | 505-250-7049
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 RIDGECREST DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-4437
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Country | US
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Telephone | 505-250-7049
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | STEPHANIE L BACA
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Credential | PT
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Telephone | 505-250-7049
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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 | 3533
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License Number State | NM
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