MEDICARE: DIANA GAIL CARTWRIGHT

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	757	NM

General Provider Information

NPI Number	:	1669957015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GAIL CARTWRIGHT

Provider Business Mailing Address
First Line	:	39 ANASAZI TRAILS LOOP
Second Line	:
City	:	PLACITAS
State	:	NM
Zip	:	87043-8761
Country	:	US
Telephone Number	:	505-321-6255
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 LAS LOMAS RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2633
Country	:	US
Telephone Number	:	505-924-2651
Fax Number	:

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

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/02/2018

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Directions to “ DIANA GAIL CARTWRIGHT ” Practice Location

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