Provider Demographics
NPI:1659543742
Name:SPINE AND MUSCLE
Entity Type:Organization
Organization Name:SPINE AND MUSCLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-822-8440
Mailing Address - Street 1:10400 ACADEMY RD NE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1229
Mailing Address - Country:US
Mailing Address - Phone:505-822-8440
Mailing Address - Fax:505-822-8460
Practice Address - Street 1:10400 ACADEMY RD NE
Practice Address - Street 2:SUITE 313
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1229
Practice Address - Country:US
Practice Address - Phone:505-822-8440
Practice Address - Fax:505-822-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4773261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4773OtherNEUROMUSCULAR THERAPIST