Provider Demographics
NPI:1255848057
Name:PHYSICAL THERAPY CARE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:KANODE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:575-742-6806
Mailing Address - Street 1:1609 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4850
Mailing Address - Country:US
Mailing Address - Phone:575-935-0360
Mailing Address - Fax:575-935-0361
Practice Address - Street 1:1609 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4850
Practice Address - Country:US
Practice Address - Phone:575-742-6806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty