Provider Demographics
NPI:1770173544
Name:BOSQUE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BOSQUE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:505-450-3451
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:BOSQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87006-0460
Mailing Address - Country:US
Mailing Address - Phone:505-450-3451
Mailing Address - Fax:
Practice Address - Street 1:227 HWY 346
Practice Address - Street 2:
Practice Address - City:BOSQUE
Practice Address - State:NM
Practice Address - Zip Code:87006
Practice Address - Country:US
Practice Address - Phone:505-450-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty