Myofascial Rehabilitation Center, LTD.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

2193 Issued in NM

Legal business name

MYOFASCIAL REHABILITATION CENTER, LTD.

Practice address

4308 Carlisle Blvd NE
Suite 207
Albuquerque, NM 87107-4856

Phone

(505) 872-3100

Fax

(505) 872-2600

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. George Sergio Pellegrino, LMT, CMTPT

Title

Vice President

Phone

(505) 872-3100

Specialties & licenses 2

Addresses

Other names 1

• MyoRehab Doing business as

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720099559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91763",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871991763",
            "telephone_number": "505-872-3100",
            "fax_number": "505-872-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4308 CARLISLE BLVD NE",
            "address_2": "SUITE 207",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871074856",
            "telephone_number": "505-872-3100",
            "fax_number": "505-872-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYOFASCIAL REHABILITATION CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PELLEGRINO",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "SERGIO",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "505-872-3100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMT, CMTPT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NM",
            "license": "2193",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NM",
            "license": "4498",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyoRehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randall T Myers, MD
• Virginia C Myers
• Zoe Myers
• Deanna Joy Fresquez Mynatt, DNP, PMHNP-BC
• Ross T Mynatt, M.O.T, OTR/L
• Jackie Myrick, LMHC
• N-Rich Physical Therapy
• Julianna Nacion, OTR/L
• Irum Z Nadeem
• Charulata Nadig, PSY.D.

• Massage Therapist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Massage Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.