Healthcare Provider Details

I. General information

NPI: 1336988005
Provider Name (Legal Business Name): PHYSICALS IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 SINGER RD
LAS CRUCES NM
88007-5566
US

IV. Provider business mailing address

5275 SINGER RD
LAS CRUCES NM
88007-5566
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-4230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TANIA DANETTE BILLSTONE-SIMPSON
Title or Position: CEO
Credential: FNP-C
Phone: 575-915-4230