Provider Demographics
NPI:1972679272
Name:RAINBOW'S PROMISE THERAPIES, INC.
Entity type:Organization
Organization Name:RAINBOW'S PROMISE THERAPIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-823-2411
Mailing Address - Street 1:5130 SAN FRANCISCO RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4618
Mailing Address - Country:US
Mailing Address - Phone:505-823-2411
Mailing Address - Fax:505-858-0650
Practice Address - Street 1:5130 SAN FRANCISCO RD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4618
Practice Address - Country:US
Practice Address - Phone:505-823-2411
Practice Address - Fax:505-858-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM695957OtherACN
NMNM00N582OtherBCBS
NM188126500OtherACS
NM26790OtherPRESBYTERIAN HEALTH PLAN