Provider Demographics
NPI:1023762424
Name:SACRED ROOTS PELVIC HEALTH AND PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SACRED ROOTS PELVIC HEALTH AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:505-609-3487
Mailing Address - Street 1:9417 ADMIRAL LOWELL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1201
Mailing Address - Country:US
Mailing Address - Phone:505-609-3487
Mailing Address - Fax:
Practice Address - Street 1:7013 4TH ST NW # E
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6639
Practice Address - Country:US
Practice Address - Phone:505-609-3487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy