Healthcare Provider Details

I. General information

NPI: 1265318976
Provider Name (Legal Business Name): MATRIX OUTPATIENT THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S MAIN ST STE C
LAS CRUCES NM
88005-2917
US

IV. Provider business mailing address

1100 S MAIN ST STE C
LAS CRUCES NM
88005-2917
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8755
  • Fax: 575-525-8795
Mailing address:
  • Phone: 575-525-8755
  • Fax: 575-525-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATE CONNOLLY
Title or Position: ADMINISTRATOR
Credential: MSN, RN
Phone: 575-525-8755