Healthcare Provider Details

I. General information

NPI: 1720573819
Provider Name (Legal Business Name): ANDREA C CARUANA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

IV. Provider business mailing address

341 S 4TH ST
RATON NM
87740-4041
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4469
  • Fax:
Mailing address:
  • Phone: 575-707-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: