Provider Demographics
NPI:1316933344
Name:SF SPORTS MED & REHAB INC
Entity type:Organization
Organization Name:SF SPORTS MED & REHAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENDRESON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:505-992-4995
Mailing Address - Street 1:104 OLD LAS VEGAS HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8199
Mailing Address - Country:US
Mailing Address - Phone:505-992-4995
Mailing Address - Fax:505-992-4985
Practice Address - Street 1:104 OLD LAS VEGAS HWY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8199
Practice Address - Country:US
Practice Address - Phone:505-992-4995
Practice Address - Fax:505-992-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty