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General NPI Number Information
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NPI Number | 1588819171
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Entity Type | Organization
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Legal Business Name | COUNTERPOISE PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 1609 SILVER HEIGHTS BLVD
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City | SILVER CITY
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State | NM
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Zip | 88061-5643
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Country | US
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Telephone | 602-318-9401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 53191
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City | PINOS ALTOS
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State | NM
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Zip | 88053-3191
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Country | US
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Telephone | 620-318-9401
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ANN ESTENSEN
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Credential | MS, PT
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Telephone | 602-318-9401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3465
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License Number State | NM
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