Healthcare Provider Details

I. General information

NPI: 1124178728
Provider Name (Legal Business Name): ELDORADO PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD UNIT 3A
SANTA FE NM
87508-9209
US

IV. Provider business mailing address

3 CALIENTE RD UNIT 3A
SANTA FE NM
87508-9209
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-2500
  • Fax: 505-466-4959
Mailing address:
  • Phone: 505-466-2500
  • Fax: 505-466-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13024
License Number StateNM

VIII. Authorized Official

Name: DEBORAH SMICK COOK
Title or Position: OWNER
Credential: PT
Phone: 505-466-2500