Organization
TRAILHEAD PELVIC & VISCERAL PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSANNA P VANDERWALT (CEO)
(505) 639-9937
Entity
Organization
Contact information
Practice address
7013 4TH ST NW STE I, LOS RANCHOS DE ALBUQUERQUE, NM 87107-6639
(505) 357-0055
Mailing address
30 ANASAZI TRAILS LOOP, PLACITAS, NM 87043-8760
(505) 639-9937
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/01/2022
Last updated
07/17/2022
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