Organization
ANTHONY L. ARVISO
Active
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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