Healthcare Provider Details

I. General information

NPI: 1023931987
Provider Name (Legal Business Name): GARY STEVEN CARRASCO JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 2ND ST NW STE B
ALBUQUERQUE NM
87114-1013
US

IV. Provider business mailing address

702 WALKER FARM RD
CARLSBAD NM
88220-5393
US

V. Phone/Fax

Practice location:
  • Phone: 505-448-3294
  • Fax:
Mailing address:
  • Phone: 575-200-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: