Organization
JEMEZ PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORRAINE L GARDNER P.T. (PRESIDENT)
(505) 661-6191
Entity
Organization
Contact information
Practice address
2101 TRINITY DR, STE N, LOS ALAMOS, NM 87544-4103
(505) 661-6191
(505) 663-0386
Mailing address
2101 TRINITY DR, STE N, LOS ALAMOS, NM 87544-4103
(505) 661-6191
(505) 663-0386
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00074159
—
NM
01
—
NM000NA25
BCBS OF NM
NM
01
—
PROVP12945
MOLINA
NM
Enumeration date
06/14/2006
Last updated
10/24/2007
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