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NPI Code Detail

MEDICARE: MIRA SOL LYMPHEDEMA REHAB CENTER LLC

MEDICARE: MIRA SOL LYMPHEDEMA REHAB CENTER 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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588744189
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIRA SOL LYMPHEDEMA REHAB CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 1560
Second Line :
City : LAS CRUCES
State : NM
Zip : 88004-1560
Country : US
Telephone Number : 505-647-8366
Fax Number : 505-647-8381
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 : 505-556-8440
Fax Number : 505-556-8439
Authorized Official
Title or Position : PHYSICIAN
Name : PETER STEINMETZ
Credential : MD
Telephone Number : 505-647-8366
Provider Enumeration Date : 10/17/2006
Last Update Date : 12/17/2007

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Directions to “MIRA SOL LYMPHEDEMA REHAB CENTER LLC ” Practice Location

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