MEDICARE: ARTESIA PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02357	OTHER	NM	LOVELACE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	26778	OTHER	NM	PRESBYTERIAN

General Provider Information

NPI Number	:	1033124490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTESIA PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 2860
Second Line	:
City	:	ALAMOGORDO
State	:	NM
Zip	:	88311-2860
Country	:	US
Telephone Number	:	575-439-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W MAHONE DR
Second Line	:
City	:	ARTESIA
State	:	NM
Zip	:	88210-2080
Country	:	US
Telephone Number	:	575-439-1397
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MELYNN PATTILLO
Credential	:
Telephone Number	:	575-439-1397

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/09/2010

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Directions to “ARTESIA PHYSICAL THERAPY LLC ” Practice Location

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