Provider Demographics
NPI:1881778462
Name:THERAPY ADVOCACY & OUTREACH INC
Entity type:Organization
Organization Name:THERAPY ADVOCACY & OUTREACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-342-1296
Mailing Address - Street 1:7213 AZTEC RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2253
Mailing Address - Country:US
Mailing Address - Phone:505-342-1296
Mailing Address - Fax:505-345-2197
Practice Address - Street 1:7213 AZTEC RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2253
Practice Address - Country:US
Practice Address - Phone:505-342-1296
Practice Address - Fax:505-345-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD3815Medicaid