MEDICARE: EL PASO THERAPY SERVICES

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	332B00000X	Durable Medical Equipment & Medical Supplies	0099069	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3823440001	OTHER	TX	MEDICARE ID

General Provider Information

NPI Number	:	1194903427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO THERAPY SERVICES

Provider Business Mailing Address
First Line	:	6065 MONTANA AVE STE B2
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1837
Country	:	US
Telephone Number	:	915-225-0519
Fax Number	:	915-225-0523

Provider Business Practice Location Address
First Line	:	6065 MONTANA AVE STE B2
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1837
Country	:	US
Telephone Number	:	915-225-0519
Fax Number	:	915-225-0523

Authorized Official
Title or Position	:	BUSINESS OFFICE DIRECTOR
Name	:	MRS. SYLVIA REYES
Credential	:
Telephone Number	:	915-587-4081

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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Directions to “EL PASO THERAPY SERVICES ” Practice Location

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