MEDICARE: FLETCHER PHYSICAL THERAPY AND CONSULTING, LLC

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

General Provider Information

NPI Number	:	1447816558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLETCHER PHYSICAL THERAPY AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	312 ROSEMONT AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-1522
Country	:	US
Telephone Number	:	505-577-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 ROSEMONT AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-1522
Country	:	US
Telephone Number	:	505-577-4334
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMY FLETCHER
Credential	:	DPT
Telephone Number	:	505-577-4334

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2019

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