Miranda Blair
Individual provider Active NPI Physical Therapist · Albuquerque, NM
NPI 1831970516 · NPPES record last updated Oct 10, 2023
Key facts
- NPI
- 1831970516
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT20232045 (NM)
- Practice address
- 505 Elm St NE
Albuquerque, NM 87102-2500 - Phone
- (505) 727-4725
- NPI assigned
- Oct 10, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- La Luz Therapy Services
Practice addresses (Care Compare)
5400 Sevilla Ave NW
Suite E
Albuquerque, NM 87120-1853
Phone (505) 363-9582
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240122003443 | NM | Practitioner - Physical Therapist in Private Practice | 8426400839 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT20232045 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Luz Therapy Services | Physical Therapist | Current |
Accepting new patients |
Locations
5400 Sevilla Ave NW
Ste E
Albuquerque, NM 87120
Phone (505) 363-9582
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT20232045 | NM | Yes |
Addresses
Primary practice location
505 Elm St NE
Albuquerque, NM 87102-2500
Mailing address
5219 Gold Rush Dr NW
Albuquerque, NM 87120-2816
Phone (505) 922-5561
Other providers in Albuquerque, NM
- Lyndel Blaine
- Savannah Nevaeh Blair Perea
- Susan Gay Blair-Buckley
- Emily Blair
- Michael Ray Blair
- Monica Blair
- Pamela Jane Blair
- Randy Lynn Blair
- Traci Gae Blair
- Traci Lee Blair
All providers in Albuquerque, 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 Oct 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.