| Myles Sandoval, | |
|
980 Bosque Farms Blvd, Bosque Farms, NM 87068-9652 | |
| (505) 554-0052 | |
| Not Available |
| Full Name | Myles Sandoval |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 980 Bosque Farms Blvd, Bosque Farms, New Mexico |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992265458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT6032 (New Mexico) | Secondary |
| 225100000X | Physical Therapist | 1316075 (Texas) | Primary |
| Provider Name | Aegis Group Practice Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1427774959 PECOS PAC ID: 5193036432 Enrollment ID: O20230605003083 |
| Mailing Address | Practice Location Address |
|---|---|
| Myles Sandoval, 145 Nara Visa Rd Nw, Albuquerque, NM 87107-6017 Ph: (512) 294-6479 | Myles Sandoval, 980 Bosque Farms Blvd, Bosque Farms, NM 87068-9652 Ph: (505) 554-0052 |
Bosque Therapy Center, Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 980 Bosque Farms Blvd, Bosque Farms, NM 87068 Phone: 505-554-0052 Fax: 833-303-1343 | |
Mr. Ettore Pittore, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2195 Bosque Farms Blvd, Bosque Farms, NM 87068 Phone: 505-916-0213 Fax: 505-916-5063 |