Healthcare Provider Details

I. General information

NPI: 1942363544
Provider Name (Legal Business Name): DAVID L HILLMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 PASEO DEL CANON E
TAOS NM
87571-6239
US

IV. Provider business mailing address

PO BOX 891
RANCHOS DE TAOS NM
87557-0891
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-5200
  • Fax: 505-758-5298
Mailing address:
  • Phone: 505-758-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number407
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: