Organization
ADVANCED REHABILITATION SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DANIELLE LYNN THIESEN (CEO)
(505) 299-2521
Entity
Organization
Contact information
Practice address
4001 JUAN TABO BLVD NE STE B, ALBUQUERQUE, NM 87111-3979
(505) 299-2521
(505) 298-8899
Mailing address
4001 JUAN TABO PLACE NE SUITE B, ALBUQUERQNE, NM 87111
(505) 299-2521
(505) 298-8899
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
IT3229
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31536859
—
NM
Enumeration date
07/05/2006
Last updated
07/29/2008
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