=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841915386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 505 THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2022
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4630 JEFFERSON LN NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-2117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-361-1931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4630 JEFFERSON LN NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87109-2117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-361-1931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PHILIP HUNTER JOCHEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-714-1663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------