MEDICARE: COUNTERPOISE PHYSICAL THERAPY

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	261QP2000X	Physical Therapy Clinic/Center	3465	NM

General Provider Information

NPI Number	:	1588819171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTERPOISE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 53191
Second Line	:
City	:	PINOS ALTOS
State	:	NM
Zip	:	88053-3191
Country	:	US
Telephone Number	:	620-318-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 SILVER HEIGHTS BLVD
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5643
Country	:	US
Telephone Number	:	602-318-9401
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	ANN ESTENSEN
Credential	:	MS, PT
Telephone Number	:	602-318-9401

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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