Provider Demographics
NPI:1073661336
Name:HBJ THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:HBJ THERAPY SERVICES, LLC
Other - Org Name:ATP THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-690-7207
Mailing Address - Street 1:3105 PUEBLO HAWIKUH
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2514
Mailing Address - Country:US
Mailing Address - Phone:505-690-7207
Mailing Address - Fax:
Practice Address - Street 1:3105 PUEBLO HAWIKUH
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2514
Practice Address - Country:US
Practice Address - Phone:505-690-7207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT0074771101Y00000X
NM0092121101YM0800X
NM1721224Z00000X
NM631225100000X
NM443225X00000X
NM3262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58334726Medicaid
NMA1098OtherDD WAIVER ID