Healthcare Provider Details

I. General information

NPI: 1710881743
Provider Name (Legal Business Name): ALEXIS ZAMORA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2801 SUDDERTH DR STE C
RUIDOSO NM
88345-6340
US

IV. Provider business mailing address

307 10TH ST
CARRIZOZO NM
88301-8009
US

V. Phone/Fax

Practice location:
  • Phone: 575-808-8721
  • Fax: 575-808-8723
Mailing address:
  • Phone: 575-808-8721
  • Fax: 575-808-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT-2026-0291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: