Healthcare Provider Details

I. General information

NPI: 1740733377
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: 08/01/2016
Last Update Date: 02/15/2017
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

PO BOX 13759
LAS CRUCES NM
88013-3759
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0484
  • Fax:
Mailing address:
  • Phone: 575-522-0484
  • 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: AVA M BORDE
Title or Position: COO
Credential:
Phone: 575-522-0484