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General NPI Number Information
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NPI Number | 1932850153
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Entity Type | Organization
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Legal Business Name | TRINITY THERAPY OF RUIDOSO LLC
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 415 WINGFIELD ST
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City | RUIDOSO
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State | NM
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Zip | 88345-9319
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Country | US
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Telephone | 575-313-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 415 WINGFIELD ST
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City | RUIDOSO
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State | NM
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Zip | 88345-9319
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Country | US
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Telephone | 575-313-2335
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ESEQUIEL MORALES
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Credential | MSPT
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Telephone | 575-313-2095
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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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