Provider Demographics
NPI:1174719546
Name:ATRIUM PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ATRIUM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/ TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:575-525-2450
Mailing Address - Street 1:1115 COMMERCE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8247
Mailing Address - Country:US
Mailing Address - Phone:575-525-2450
Mailing Address - Fax:
Practice Address - Street 1:1115 COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8247
Practice Address - Country:US
Practice Address - Phone:575-525-2450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00N491OtherBCBSNM
650019370OtherRAILROAD MEDICARE
NM00K8214Medicaid
NM201079788OtherPRESBYTERIAN
NMS58863Medicare UPIN
650019370OtherRAILROAD MEDICARE