Healthcare Provider Details

I. General information

NPI: 1588819171
Provider Name (Legal Business Name): COUNTERPOISE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 SILVER HEIGHTS BLVD
SILVER CITY NM
88061-5643
US

IV. Provider business mailing address

PO BOX 53191
PINOS ALTOS NM
88053-3191
US

V. Phone/Fax

Practice location:
  • Phone: 602-318-9401
  • Fax:
Mailing address:
  • Phone: 620-318-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3465
License Number StateNM

VIII. Authorized Official

Name: ANN ESTENSEN
Title or Position: PHYSICAL THERAPIST
Credential: MS, PT
Phone: 602-318-9401