MEDICARE: LILY ARITE 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
1	225200000X	Physical Therapy Assistant	1499	NM

General Provider Information

NPI Number	:	1538657135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY ARITE PTA

Provider Business Mailing Address
First Line	:	1845 SAINT ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2857
Country	:	US
Telephone Number	:	505-977-3843
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 SAINT ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2857
Country	:	US
Telephone Number	:	505-977-3843
Fax Number	:

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

Provider Enumeration Date	:	04/29/2018
Last Update Date	:	04/29/2018

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