Provider Demographics
NPI:1811256860
Name:THREE RIVERS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:THREE RIVERS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:910-353-9800
Mailing Address - Street 1:20104 RIDGEFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3301
Mailing Address - Country:US
Mailing Address - Phone:910-353-9800
Mailing Address - Fax:605-269-2146
Practice Address - Street 1:3701 MESSINA DRIVE
Practice Address - Street 2:#108
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8740
Practice Address - Country:US
Practice Address - Phone:505-258-4003
Practice Address - Fax:505-436-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy