Healthcare Provider Details

I. General information

NPI: 1346184561
Provider Name (Legal Business Name): ALYSSA MAE BETIA MONTEMAYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 PASEO DEL PUEBLO SUR
TAOS NM
87571-6758
US

IV. Provider business mailing address

606 N DUSTIN AVE
FARMINGTON NM
87401-6120
US

V. Phone/Fax

Practice location:
  • Phone: 575-613-1240
  • Fax:
Mailing address:
  • Phone: 505-439-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2023-2276
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: