Healthcare Provider Details

I. General information

NPI: 1003139726
Provider Name (Legal Business Name): CHRIS KOTTER M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 INDIAN WELLS
ALAMOGORDO NM
88310-5012
US

IV. Provider business mailing address

PO BOX 2860
ALAMOGORDO NM
88311-2860
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-1397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3836
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: