Healthcare Provider Details

I. General information

NPI: 1114222924
Provider Name (Legal Business Name): MONICA A PREROVSKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 SAN YSIDRO PLACE
SANTA FE NM
87507
US

IV. Provider business mailing address

4671 SAN YSIDRO PLACE
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-3326
  • Fax: 505-988-7187
Mailing address:
  • Phone: 505-577-3326
  • Fax: 505-988-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2683
License Number StateNM

VIII. Authorized Official

Name: MONICA ANN PREROVSKY
Title or Position: PHYSICAL THERAPIST
Credential: MPT
Phone: 505-577-3326