Liza Black

Individual provider Active NPI Physical Therapist · Edgewood, NM

NPI 1972049153 · NPPES record last updated Jan 12, 2017

Key facts

NPI
1972049153
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
2936 (NM)
Practice address
1 Linnie Court
Edgewood, NM 87015
Phone
(505) 268-7838
NPI assigned
Jan 12, 2017
Sex
Female
Sole proprietor
No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Practice roles

OrganizationSpecialtyStatusNew patients
Active Solutions Therapy Services, Inc Physical Therapist Past Accepting new patients
Rio Rancho Physical Therapy Past
since Aug 19, 1996
Accepting new patients
Armada Physical Therapy of Albuquerque LLC Past
since Oct 1, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2936 NM Yes

Addresses

Primary practice location

1 Linnie Court
Edgewood, NM 87015

Mailing address

8904 Armistice Rd NE
Albuquerque, NM 87109-5140

Other providers in Edgewood, NM

All providers in Edgewood, NM · Physical Therapist in New Mexico

Sources for this page

Verify at the official NPI Registry.