MEDICARE: STEVE P. WAGHORN PT,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3129	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00253827	OTHER	NM	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3129	OTHER	NM	NM STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1245380039	OTHER	NM	BERNALILLO FACILITY NPI
5	1356491146	OTHER	NM	BELEN FACILITY NPI
6	1386651412	OTHER	NM	LOS LUNAS FACILITY NPI

General Provider Information

NPI Number	:	1326062423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE P. WAGHORN PT,MS

Provider Business Mailing Address
First Line	:	535 HIGHWAY 314 SW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-9600
Country	:	US
Telephone Number	:	505-866-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 HIGHWAY 314 SW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-9600
Country	:	US
Telephone Number	:	505-866-0055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/19/2010

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Directions to “ STEVE P. WAGHORN PT,MS” Practice Location

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