Provider Demographics
NPI:1881601375
Name:LOS NINOS THERAPY CENTER
Entity type:Organization
Organization Name:LOS NINOS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI ANN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:505-865-7955
Mailing Address - Street 1:PO BOX 1436
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-1436
Mailing Address - Country:US
Mailing Address - Phone:505-865-7955
Mailing Address - Fax:505-866-7191
Practice Address - Street 1:336 LUNA AVENUE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-865-7955
Practice Address - Fax:505-866-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD0641Medicaid
NM695951OtherUNITED HEALTHCARE
NMNN00N637OtherBLUE CROSS BLUE SHIELD
NMQMYPR0072204OtherMOLINA HEALTHCARE OF NM
NMK2312Medicaid
NMK2312Medicaid