Organization
INDEPENDENT LIVING THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVYROSE GONZALES MOTR/L (OCCUPATIONAL THERAPIST)
(505) 350-3069
Entity
Organization
Contact information
Practice address
12105 DAN PATCH RD SE, ALBUQUERQUE, NM 87123-2196
(505) 350-3069
(505) 508-2305
Mailing address
12105 DAN PATCH RD SE, ALBUQUERQUE, NM 87123-2196
(505) 350-3069
(505) 508-2305
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93985312
—
NM
Enumeration date
09/29/2010
Last updated
09/29/2010
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