Gordon Henriksen
Individual provider Active NPI Physical Therapist · Aztec, NM
NPI 1386916583 · NPPES record last updated Feb 2, 2012
Key facts
- NPI
- 1386916583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2498 (NM)
- Practice address
- 1607 W Aztec Blvd
Aztec, NM 87410-1805 - Phone
- (505) 334-3695
- NPI assigned
- Feb 2, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2498 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aztec Municipal Schools | Past | Accepting new patients | |
| Aztec Municipal School District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2498 | NM | Yes |
Addresses
Primary practice location
1607 W Aztec Blvd
Aztec, NM 87410-1805
Mailing address
2006 Eastlawn Ave
Durango, CO 81301-4835
Other providers in Aztec, NM
- Crystal Goss
- Summer Graham
- Sara Gutierrez
- Roy Edward Harrington
- Savannah Claire Hazelwood
- Ian T Kirste OD PC
- Drew Jackson
- Christen Marie Janney
- Kendill May Jones
- Kare Inc
All providers in Aztec, NM · Physical Therapist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.