Healthcare Provider Details

I. General information

NPI: 1841205200
Provider Name (Legal Business Name): CARLSBAD PHYSICAL THERAPY & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S CANYON ST
CARLSBAD NM
88220-5733
US

IV. Provider business mailing address

PO BOX 2860
ALAMOGORDO NM
88311-2860
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-1397
  • Fax: 575-437-2622
Mailing address:
  • Phone: 575-439-1397
  • Fax: 575-437-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT J PATTILLO
Title or Position: PRESIDENT, ADMINISTRATIVE MANAGER
Credential: PT
Phone: 575-439-1397