Provider Demographics
NPI:1114282340
Name:PHYSICAL THERAPY AT DAWN INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AT DAWN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-242-2294
Mailing Address - Street 1:600 CENTRAL AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3656
Mailing Address - Country:US
Mailing Address - Phone:505-242-2294
Mailing Address - Fax:505-242-2917
Practice Address - Street 1:6330 RIVERSIDE PLAZA LN NW
Practice Address - Street 2:SUITE 150
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2681
Practice Address - Country:US
Practice Address - Phone:505-242-2294
Practice Address - Fax:505-242-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty