Provider Demographics
NPI:1962529974
Name:INDUSTRIAL REHABILITATION CLINIC, PC
Entity type:Organization
Organization Name:INDUSTRIAL REHABILITATION CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:REEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-797-7691
Mailing Address - Street 1:1691 GALISTEO ST
Mailing Address - Street 2:SUITE C2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4780
Mailing Address - Country:US
Mailing Address - Phone:505-983-9400
Mailing Address - Fax:505-983-9417
Practice Address - Street 1:1691 GALISTEO ST
Practice Address - Street 2:SUITE C2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4780
Practice Address - Country:US
Practice Address - Phone:505-983-9400
Practice Address - Fax:505-983-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty