1669429189 NPI number — ABEYTA PHYSICAL THERAPY & SPORTS MEDICINE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669429189 NPI number — ABEYTA PHYSICAL THERAPY & SPORTS MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABEYTA PHYSICAL THERAPY & SPORTS MEDICINE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669429189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 ARENAS VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER CITY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 E MOTEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORDSBURG
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-313-3438
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABEYTA
Authorized Official First Name:
RUBEN
Authorized Official Middle Name:
Q.
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
505-313-3438

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3107 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 88775763 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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