Healthcare Provider Details

I. General information

NPI: 1376328559
Provider Name (Legal Business Name): ZACHARY DEANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N RICHARDSON AVE
ROSWELL NM
88201-4920
US

IV. Provider business mailing address

208 W 9TH ST
ROSWELL NM
88201-4904
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-6260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216018
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2025-0355
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: