MEDICARE: PHYSICALS IN MOTION

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	207Q00000X	Family Medicine Physician
2	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1336988005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICALS IN MOTION

Provider Business Mailing Address
First Line	:	5275 SINGER RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5275 SINGER RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5566
Country	:	US
Telephone Number	:	575-915-4230
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TANIA DANETTE BILLSTONE-SIMPSON
Credential	:	FNP-C
Telephone Number	:	575-915-4230

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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Directions to “PHYSICALS IN MOTION ” Practice Location

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