Healthcare Provider Details

I. General information

NPI: 1518623669
Provider Name (Legal Business Name): ALPINE FINISH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 PASEO DEL PUEBLO NORTE
EL PRADO NM
87529
US

IV. Provider business mailing address

623 ACADEMY LN
TAOS NM
87571-6416
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN FUSTING
Title or Position: PRINCIPAL
Credential: DPT
Phone: 575-770-5661