Healthcare Provider Details

I. General information

NPI: 1326961780
Provider Name (Legal Business Name): TEOFILO CARRASCO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-7343
US

IV. Provider business mailing address

1400 SUE CT
LAS CRUCES NM
88007-5524
US

V. Phone/Fax

Practice location:
  • Phone: 575-222-0188
  • Fax:
Mailing address:
  • Phone: 575-222-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20260225
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: