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General NPI Number Information
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NPI Number | 1972679272
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Entity Type | Organization
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Legal Business Name | RAINBOW'S PROMISE THERAPIES, INC.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 5130 SAN FRANCISCO RD NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4618
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Country | US
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Telephone | 505-823-2411
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Fax | 505-858-0650
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Provider Business Mailing Address
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Address Line | 5130 SAN FRANCISCO RD NE STE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4618
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Country | US
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Telephone | 505-823-2411
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Fax | 505-858-0650
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | THOMAS STATON
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Credential | PT
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Telephone | 505-823-2411
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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 | 6761
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License Number State | NM
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