Healthcare Provider Details

I. General information

NPI: 1912922808
Provider Name (Legal Business Name): OLGA M. SACASA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 US HIGHWAY 314, SW
LOS LUNAS NM
87031
US

IV. Provider business mailing address

535 US HIGHWAY 314, SW
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-861-1200
  • Fax: 505-861-1220
Mailing address:
  • Phone: 505-861-1200
  • Fax: 505-861-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2549
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: