Provider Demographics
NPI:1922139427
Name:ALLCARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ALLCARE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARCELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-471-0818
Mailing Address - Street 1:PO BOX 34130
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-4130
Mailing Address - Country:US
Mailing Address - Phone:505-471-0818
Mailing Address - Fax:505-471-0822
Practice Address - Street 1:1401 MACLOVIA STREET
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3293
Practice Address - Country:US
Practice Address - Phone:505-471-0818
Practice Address - Fax:505-471-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0796B63225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty