Healthcare Provider Details

I. General information

NPI: 1841146172
Provider Name (Legal Business Name): BRIAN JAMES RATHBUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

IV. Provider business mailing address

4151 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2026-0047
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: