Provider Demographics
NPI:1033115050
Name:NEW MEXICO PHYSICAL THERAPISTS INC
Entity Type:Organization
Organization Name:NEW MEXICO PHYSICAL THERAPISTS INC
Other - Org Name:VIBRANTCARE REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-782-1212
Mailing Address - Street 1:PO BOX 840255
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0255
Mailing Address - Country:US
Mailing Address - Phone:916-789-8115
Mailing Address - Fax:916-773-1481
Practice Address - Street 1:2211 MAIN ST NE
Practice Address - Street 2:STE. C
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-885-1677
Practice Address - Fax:505-855-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM326537Medicare PIN