=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760366009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN ROSE LAINTZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 BECKNER RD
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87507-3774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-477-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 261 CANADA WAY
-----------------------------------------------------
City | LOS ALAMOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87547-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-672-3507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PT-2025-0103
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------