Provider Demographics
NPI:1225547706
Name:COREPHYSIO, LLC
Entity Type:Organization
Organization Name:COREPHYSIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-983-2673
Mailing Address - Street 1:1850 OLD PECOS TRL STE H
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4760
Mailing Address - Country:US
Mailing Address - Phone:505-983-2673
Mailing Address - Fax:505-832-3321
Practice Address - Street 1:1850 OLD PECOS TRAIL
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4760
Practice Address - Country:US
Practice Address - Phone:505-983-2673
Practice Address - Fax:505-832-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1833261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy