MEDICARE: ARREN R POWELL 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	A0849	NM

General Provider Information

NPI Number	:	1619240900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARREN R POWELL PTA

Provider Business Mailing Address
First Line	:	PO BOX 2860
Second Line	:
City	:	ALAMOGORDO
State	:	NM
Zip	:	88311-2860
Country	:	US
Telephone Number	:	575-439-1397
Fax Number	:	575-437-2622

Provider Business Practice Location Address
First Line	:	601 W MAHONE DR
Second Line	:
City	:	ARTESIA
State	:	NM
Zip	:	88210-2080
Country	:	US
Telephone Number	:	575-439-1397
Fax Number	:	575-437-2622

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

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	07/11/2013

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