Healthcare Provider Details

I. General information

NPI: 1316218910
Provider Name (Legal Business Name): PHYSICAL THERAPY AND REHABILITATION SERVICES OF LAS CRUCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/20/2017
Certification Date:
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: 575-522-0483
Mailing address:
  • Phone: 575-522-0484
  • Fax: 575-522-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1564
License Number StateNM

VIII. Authorized Official

Name: AVA M BORDE
Title or Position: COO
Credential:
Phone: 575-522-0484