Healthcare Provider Details

I. General information

NPI: 1942224480
Provider Name (Legal Business Name): DEBORAH SMICK COOK MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COOK RUTH SMICK

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3 CALIENTE RD UNIT 3-A
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 Number2044
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: