MEDICARE: NEW MEXICO PHYSICAL THERAPISTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		NM

General Provider Information

NPI Number	:	1033115050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO PHYSICAL THERAPISTS INC

Provider Business Mailing Address
First Line	:	PO BOX 840255
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-0255
Country	:	US
Telephone Number	:	916-789-8115
Fax Number	:	916-773-1481

Provider Business Practice Location Address
First Line	:	2211 MAIN ST NE
Second Line	:	STE. C
City	:	LOS LUNAS
State	:	NM
Zip	:	87031
Country	:	US
Telephone Number	:	505-885-1677
Fax Number	:	505-855-1767

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID SMITH
Credential	:
Telephone Number	:	916-782-1212

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/22/2023

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