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NPI Code Detail

MEDICARE: MICHAEL GURULE PTA

MEDICARE: MICHAEL GURULE PTA
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
1225200000XPhysical Therapy AssistantPTA1137NM

General Provider Information

NPI Number : 1376391276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL GURULE PTA
Provider Business Mailing Address
First Line : 4400 N SONOMA RANCH BLVD STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7343
Country : US
Telephone Number : 575-222-0188
Fax Number : 575-652-4142
Provider Business Practice Location Address
First Line : 4400 N SONOMA RANCH BLVD STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7343
Country : US
Telephone Number : 575-222-0188
Fax Number : 575-652-4142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2024
Last Update Date : 05/07/2024

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Directions to “ MICHAEL GURULE PTA” Practice Location

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