Provider Demographics
NPI:1316974017
Name:SPRINT SPORTS REHABILITATION INC
Entity type:Organization
Organization Name:SPRINT SPORTS REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-622-6500
Mailing Address - Street 1:113 E COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5158
Mailing Address - Country:US
Mailing Address - Phone:575-622-6500
Mailing Address - Fax:575-622-9777
Practice Address - Street 1:113 E COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5158
Practice Address - Country:US
Practice Address - Phone:575-622-6500
Practice Address - Fax:575-622-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00971367Medicaid
NM00971367Medicaid