Healthcare Provider Details

I. General information

NPI: 1063345189
Provider Name (Legal Business Name): ALYSSA LAXINA ALBANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

1531 N MAIN AVE APT 425
LOVINGTON NM
88260-2870
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2024-0096
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: