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General NPI Number Information
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NPI Number | 1649524117
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Entity Type | Organization
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Legal Business Name | CUATITAS PHYSICAL & SPORTS THERAPY
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 2503 RIDGE RUNNER RD
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City | LAS VEGAS
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State | NM
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Zip | 87701-4972
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Country | US
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Telephone | 505-454-1078
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Fax | 505-454-1164
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Provider Business Mailing Address
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Address Line | 519 VEGAS DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-4690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MARIO J LUCERO
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Credential |
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Telephone | 505-715-3451
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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 | 3441
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License Number State | NM
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