Organization
ANTHONY L. ARVISO
Active
Other names
Enchantment Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY LIONEL ARVISO PT (OWNER)
(505) 863-4199
Entity
Organization
Contact information
Practice address
1900 E HISTORIC HIGHWAY 66, SUITE 5, GALLUP, NM 87301-4883
(505) 863-4199
(505) 863-4196
Mailing address
1900 E HISTORIC HIGHWAY 66, SUITE 5, GALLUP, NM 87301-4883
(505) 863-4199
(505) 863-4196
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2151
NM
261QP2000X
Physical Therapy Clinic/Center
2734
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
313193
AHCCCS
AZ
05
—
58607269
—
NM
Enumeration date
12/01/2010
Last updated
12/01/2010
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