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General NPI Number Information
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NPI Number | 1205934619
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Entity Type | Organization
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Legal Business Name | TAOS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 414 SIPAPU STREET
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City | TAOS
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State | NM
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Zip | 87571-6498
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Country | US
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Telephone | 575-758-8761
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Fax | 575-751-0448
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Provider Business Mailing Address
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Address Line | 6955 NDCBU
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City | TAOS
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State | NM
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Zip | 87571-6498
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Country | US
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Telephone | 575-758-8761
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Fax | 575-751-0448
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ALICIA B. ESPARZA
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Credential | P.T.
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Telephone | 575-758-8761
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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 |
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License Number State |
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