MEDICARE: VENTANA THERAPY CENTER LIMITED

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		NM

General Provider Information

NPI Number	:	1770520371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENTANA THERAPY CENTER LIMITED

Provider Business Mailing Address
First Line	:	1300 W SAM HOUSTON PKWY S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2453
Country	:	US
Telephone Number	:	713-297-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	141S ROADRUNNER PKWY
Second Line	:	STE 111
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2000
Country	:	US
Telephone Number	:	505-532-8210
Fax Number	:	505-532-8209

Authorized Official
Title or Position	:	VICE PRESIDENT OF LEGAL
Name	:	JANNA P. KING
Credential	:	JD
Telephone Number	:	713-297-7014

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/07/2009

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