MEDICARE: DOMINIC SUBEBE ADOLFO PT

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	225100000X	Physical Therapist	PT5386	NM

General Provider Information

NPI Number	:	1417656034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC SUBEBE ADOLFO PT

Provider Business Mailing Address
First Line	:	625 CARDENAS DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 CARDENAS DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-3723
Country	:	US
Telephone Number	:	505-537-7183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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Directions to “ DOMINIC SUBEBE ADOLFO PT” Practice Location

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