Healthcare Provider Details

I. General information

NPI: 1083570840
Provider Name (Legal Business Name): KATHERINE BACA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N CANAL ST
CARLSBAD NM
88220-5873
US

IV. Provider business mailing address

10506 BLACK WALNUT DR
DALLAS TX
75243-5109
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-1814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: