Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT37189 | CA |
Y | 2251N0400X | Physical Therapist - Neurology | 3935 | NM |
NPI | 1437445566 |
---|---|
Provider Name | Ricardo Amaya |
First Address | Albuquerque, NM 87102-2500 |
Second Address | Albuquerque, NM 87102-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 27/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3935 | (05) | NM |