Provider Demographics
NPI:1447816558
Name:FLETCHER PHYSICAL THERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:FLETCHER PHYSICAL THERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:505-577-4334
Mailing Address - Street 1:312 ROSEMONT AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1522
Mailing Address - Country:US
Mailing Address - Phone:505-577-4334
Mailing Address - Fax:
Practice Address - Street 1:312 ROSEMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1522
Practice Address - Country:US
Practice Address - Phone:505-577-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy