Organization
PHYSICAL THERAPY CENTER, LLC
Active
Other names
Physical Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
LOGAN ARDEN KANODE DPT (OWNER)
(505) 454-1213
Entity
Organization
Contact information
Practice address
1607 7TH ST STE C, LAS VEGAS, NM 87701-4952
(505) 454-1213
Mailing address
PO BOX 2694, LAS VEGAS, NM 87701-2694
(505) 454-1213
(505) 425-2798
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
4234
NM
261QP2000X
Physical Therapy Clinic/Center
Primary
4234
NM
Other
Enumeration date
11/17/2012
Last updated
06/18/2014
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