Provider Demographics
NPI:1013658996
Name:AGAPE PHYSICAL THERAPY & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:AGAPE PHYSICAL THERAPY & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LLEWELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-449-7002
Mailing Address - Street 1:2170 E LOHMAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8440
Mailing Address - Country:US
Mailing Address - Phone:575-449-7002
Mailing Address - Fax:575-652-4684
Practice Address - Street 1:2170 E LOHMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8440
Practice Address - Country:US
Practice Address - Phone:575-449-7002
Practice Address - Fax:575-652-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty