Provider Demographics
NPI:1003557315
Name:MOUNTAIN MEADOW THERAPY
Entity Type:Organization
Organization Name:MOUNTAIN MEADOW THERAPY
Other - Org Name:MOUNTAIN MEADOW THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-629-3141
Mailing Address - Street 1:3 CALIENTE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9208
Mailing Address - Country:US
Mailing Address - Phone:505-436-1163
Mailing Address - Fax:505-636-5172
Practice Address - Street 1:3 CALIENTE RD
Practice Address - Street 2:STE 6
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9208
Practice Address - Country:US
Practice Address - Phone:505-603-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty