Trailhead Pelvic & Visceral Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

TRAILHEAD PELVIC & VISCERAL PHYSICAL THERAPY LLC

Practice address

7013 4TH St NW Ste I
Los Ranchos de Albuquerque, NM 87107-6639

Phone

(505) 357-0055

NPI assigned

Jun 1, 2022

Last updated

Jul 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susanna P Vanderwalt

Title

Ceo

Phone

(505) 639-9937

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susanna (Sunel) P Van Der Walt, DPT

  • Pediatric Physical Therapist
  • Albuquerque, NM
  • NPI 1124410519
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658016000000",
    "number": "1023757747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 ANASAZI TRAILS LOOP",
            "city": "PLACITAS",
            "state": "NM",
            "postal_code": "870438760",
            "telephone_number": "505-639-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7013 4TH ST NW STE I",
            "city": "LOS RANCHOS DE ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871076639",
            "telephone_number": "505-357-0055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7013 4th St NW Ste I",
            "address_purpose": "LOCATION",
            "city": "Los Ranchos de Albuquerque",
            "state": "NM",
            "postal_code": "871076639",
            "country_code": "US",
            "telephone_number": "505-357-0055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRAILHEAD PELVIC & VISCERAL PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-07-17",
        "certification_date": "2022-07-17",
        "status": "A",
        "authorized_official_last_name": "VANDERWALT",
        "authorized_official_first_name": "SUSANNA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-639-9937",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dessie Montoya-Soto, M.S. CCC-SLP
• Eligio Roberto Padilla, PH.D.
• Robert Ericson, PHD
• Minerva Santana, M.A.,CCC-SLP
• Tansy M. Briggs, Dom, L.L.C.
• Berna Tuncel Jove Colon, PHARMACIST
• Claudia Welch, DOM

• Physical Therapist in Los Ranchos de Albuquerque, NM
• Providers in Los Ranchos de Albuquerque, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.