Provider Demographics
NPI:1427544493
Name:PIRC, PETRA (MSPT)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:PIRC
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:PETRA
Other - Middle Name:
Other - Last Name:PIRC MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1350 CENTRAL AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-6217
Mailing Address - Country:US
Mailing Address - Phone:505-662-3384
Mailing Address - Fax:
Practice Address - Street 1:1350 CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-6217
Practice Address - Country:US
Practice Address - Phone:505-662-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2919OtherSTATE OF NEW MEXICO