Provider Demographics
NPI:1376648733
Name:SPECIAL K FITNESS, INC.
Entity Type:Organization
Organization Name:SPECIAL K FITNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-326-2460
Mailing Address - Street 1:3180 N. BUTLER AVE.
Mailing Address - Street 2:BLDG. 300
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-326-2460
Mailing Address - Fax:505-325-1943
Practice Address - Street 1:3180 N. BUTLER AVE.
Practice Address - Street 2:BLDG. 300
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-326-2460
Practice Address - Fax:505-325-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00Q233OtherBCBS