Healthcare Provider Details

I. General information

NPI: 1780558742
Provider Name (Legal Business Name): ISABELLA BERNINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 SUDDERTH DR
RUIDOSO NM
88345-6002
US

IV. Provider business mailing address

213 SUDDERTH DR
RUIDOSO NM
88345-6002
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-8239
  • Fax: 575-257-8200
Mailing address:
  • Phone: 575-257-8239
  • Fax: 575-257-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2025-0141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: