Provider Demographics
NPI:1588973077
Name:SW BRIAN INTEGRATION THERAPY & REHAB LLC
Entity type:Organization
Organization Name:SW BRIAN INTEGRATION THERAPY & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STAR
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:RIDSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-239-9644
Mailing Address - Street 1:10900 TANZANITE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1853
Mailing Address - Country:US
Mailing Address - Phone:505-239-2958
Mailing Address - Fax:505-896-2958
Practice Address - Street 1:1005 21 ST. SE
Practice Address - Street 2:SUITE # 4
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-239-9644
Practice Address - Fax:505-896-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty