Provider Demographics
NPI:1558654780
Name:ARC PHYSICAL THERAPY, SPORTS AND REHAB, LLC
Entity type:Organization
Organization Name:ARC PHYSICAL THERAPY, SPORTS AND REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOERNING
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:505-795-5293
Mailing Address - Street 1:399 CALLE COLINA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1017
Mailing Address - Country:US
Mailing Address - Phone:505-795-0372
Mailing Address - Fax:505-982-9770
Practice Address - Street 1:1651 GALISTEO ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4752
Practice Address - Country:US
Practice Address - Phone:505-795-5293
Practice Address - Fax:505-982-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty