Organization
THI OF NEW MEXICO THERAPY, LLC
Active
Other names
BalanceOne Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WENCLAWIAK III (PRESIDENT)
(505) 828-2400
Entity
Organization
Contact information
Practice address
8814 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
(505) 828-2400
Mailing address
930 RIDGEBROOK RD, SPARKS, MD 21152-9390
(410) 773-1000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96839031
—
NM
Enumeration date
05/05/2006
Last updated
03/10/2008
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