Provider Demographics
NPI:1689635625
Name:INIGUEZ PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INIGUEZ PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:INIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:575-388-0430
Mailing Address - Street 1:1310 N POPE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:505-388-0430
Mailing Address - Fax:505-388-0460
Practice Address - Street 1:1310 N POPE ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:505-388-0430
Practice Address - Fax:505-388-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1919225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53106750Medicaid
NM0000L2945Medicaid