Healthcare Provider Details

I. General information

NPI: 1295668812
Provider Name (Legal Business Name): JUSTIN CASEY TAPSCOTT C.PED., CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 E LOHMAN AVE STE 4
LAS CRUCES NM
88011-8296
US

IV. Provider business mailing address

3851 E LOHMAN AVE STE 4
LAS CRUCES NM
88011-8296
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-5611
  • Fax: 575-483-7224
Mailing address:
  • Phone: 575-993-5611
  • Fax: 575-483-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFO00552
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED4958
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: