Provider Demographics
NPI:1952307274
Name:SOUTHWEST THERAPISTS INC
Entity Type:Organization
Organization Name:SOUTHWEST THERAPISTS INC
Other - Org Name:NOVACARE OUTPATIENT REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-782-1212
Mailing Address - Street 1:2270 DOUGLAS BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3869
Mailing Address - Country:US
Mailing Address - Phone:916-782-1212
Mailing Address - Fax:916-773-1481
Practice Address - Street 1:118 S IRON ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3628
Practice Address - Country:US
Practice Address - Phone:505-546-2649
Practice Address - Fax:505-546-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM326507Medicare PIN