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General NPI Number Information
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NPI Number | 1144236258
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Entity Type | Individual
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Provider Name | LYDIA C. RADOSEVICH P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 439 MECHEM DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6813
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Country | US
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Telephone | 505-257-1800
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Fax | 505-257-2319
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Provider Business Mailing Address
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Address Line | 439 MECHEM DR.
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City | RUIDOSO
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State | NM
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Zip | 88345
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Country | US
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Telephone | 505-257-1800
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Fax | 505-257-2319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1781
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License Number State | NM
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