Healthcare Provider Details

I. General information

NPI: 1225507957
Provider Name (Legal Business Name): PROACTIVE MOTION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11199 PELLICANO DR
EL PASO TX
79935-5304
US

IV. Provider business mailing address

1075 WHIRL AWAY DR
EL PASO TX
79936-7830
US

V. Phone/Fax

Practice location:
  • Phone: 915-276-4286
  • Fax: 915-206-2610
Mailing address:
  • Phone: 915-204-1760
  • Fax: 915-206-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA FLORES
Title or Position: PRESIDENT
Credential: OT
Phone: 915-204-1760