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NPI Code Detail

MEDICARE: MARYGRACE ARTILLAGA PT

MEDICARE: MARYGRACE ARTILLAGA PT
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 Therapist4407NM

General Provider Information

NPI Number : 1891118741
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYGRACE ARTILLAGA PT
Provider Business Mailing Address
First Line : 2884 N ROADRUNNER PKWY
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-0853
Country : US
Telephone Number : 512-429-8151
Fax Number :
Provider Business Practice Location Address
First Line : 2884 N ROADRUNNER PKWY
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-0853
Country : US
Telephone Number : 512-429-8151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2014
Last Update Date : 01/29/2014

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Directions to “ MARYGRACE ARTILLAGA PT” Practice Location

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