MEDICARE: MRS. CAROLYN ANNE AHEARN MSPT

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	225100000X	Physical Therapist	4070	NM

General Provider Information

NPI Number	:	1184833444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN ANNE AHEARN MSPT

Provider Business Mailing Address
First Line	:	2455 MISSOURI AVE
Second Line	:	SUITE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5122
Country	:	US
Telephone Number	:	575-556-8440
Fax Number	:	575-556-8439

Provider Business Practice Location Address
First Line	:	2455 MISSOURI AVE
Second Line	:	SUITE B
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5122
Country	:	US
Telephone Number	:	575-556-8440
Fax Number	:	575-556-8439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/04/2015

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