Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2894 | NM |
NPI | 1003025164 |
---|---|
Provider Name | Rebecca A Vidos-Roland |
First Address | Albuquerque, NM 87109-1210 |
Second Address | Albuquerque, NM 87109-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 26/10/2016 |