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NPI Code Detail

MEDICARE: MRS. SHEILA MARIE BACA PTA

MEDICARE: MRS. SHEILA MARIE BACA PTA
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
1225200000XPhysical Therapy AssistantPTA-1422NM

General Provider Information

NPI Number : 1477107241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHEILA MARIE BACA PTA
Provider Business Mailing Address
First Line : 3701 MESSINA DR STE 108
Second Line :
City : FARMINGTON
State : NM
Zip : 87402-4780
Country : US
Telephone Number : 505-258-4003
Fax Number : 505-436-2740
Provider Business Practice Location Address
First Line : 3701 MESSINA DR STE 108
Second Line :
City : FARMINGTON
State : NM
Zip : 87402-4780
Country : US
Telephone Number : 505-258-4003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2019
Last Update Date : 07/30/2019

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Directions to “ MRS. SHEILA MARIE BACA PTA” Practice Location

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