Myles Sandoval
Individual provider Active NPI Physical Therapist · Bosque Farms, NM
NPI 1992265458 · NPPES record last updated Oct 27, 2022
Key facts
- NPI
- 1992265458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1316075 (TX)
- Practice address
- 980 Bosque Farms Blvd
Bosque Farms, NM 87068-9652 - Phone
- (505) 554-0052
- NPI assigned
- Mar 21, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT6032 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aegis Group Practice LLC | Single Specialty | Current |
Accepting new patients |
| Bosque Therapy Center, LLC | Physical Therapist | Current |
Accepting new patients |
| Aegis Group Practice LLC | Physical Therapist | Current |
Accepting new patients |
| The ABA Spot LLC | Single Specialty | Past | Accepting new patients |
Locations
4933 Old Greenwood Rd
Fort Smith, AR 72903
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT6032 | NM | |
| Physical Therapist |
225100000X | 1316075 | TX | Yes |
Addresses
Primary practice location
980 Bosque Farms Blvd
Bosque Farms, NM 87068-9652
Mailing address
145 Nara Visa Rd NW
Albuquerque, NM 87107-6017
Phone (512) 294-6479
Other practice location 1
14683 Midway Rd Ste 160
Addison, TX 75001-3188
Phone (214) 483-3170
Other providers in Bosque Farms, NM
- Kreig Robert Peterson
- Ettore Pittore
- Michelle Randall
- Kelly Robinson
- Korah Makayla Roybal
- Stacie Shain
- Matthew Smith
- Southwest Medical Clinic Inc
- Martha Brown Swinney
- Teekees Clinic
All providers in Bosque Farms, 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 27, 2022. 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.