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General NPI Number Information
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NPI Number | 1992484810
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Entity Type | Organization
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Legal Business Name | OPTAH PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 467 ROCKWAY BLVD NE
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City | RIO RANCHO
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State | NM
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Zip | 87124-4473
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Country | US
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Telephone | 505-319-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 467 ROCKWAY BLVD NE
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City | RIO RANCHO
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State | NM
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Zip | 87124-4473
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Country | US
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Telephone | 505-319-8564
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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 | LAINIE GARCIA
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Credential | MPT, MLD CERTIFIED
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Telephone | 505-319-8564
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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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