Organization
NEW MEXICO SPORTS & PT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS H FAGAN P T (PRESIDENT)
(505) 424-0131
Entity
Organization
Contact information
Practice address
2954 RODEO PARK DR W, SANTA FE, NM 87505-6351
(505) 424-0131
(505) 424-1299
Mailing address
2954 RODEO PARK DR W, SANTA FE, NM 87505-6351
(505) 424-0131
(505) 424-1299
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
6292
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N4536
—
NM
Enumeration date
10/20/2006
Last updated
06/01/2017
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