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General NPI Number Information
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NPI Number | 1831427699
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Entity Type | Organization
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Legal Business Name | INDIGO THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 12/05/2009
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 7103 4TH ST NW SUITE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6641
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Country | US
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Telephone | 505-508-0505
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Fax | 505-508-0505
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Provider Business Mailing Address
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Address Line | 6817 ACADEMY PARKWAY WEST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4405
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Country | US
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Telephone | 505-508-0505
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Fax | 505-312-8414
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Authorized Official
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Title or Position | OWNER-VICE PRESIDENT
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Name | TERRY B DILLARD
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Credential |
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Telephone | 505-508-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 423
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License Number State | NM
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