MEDICARE: TONY FLORES 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
1	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A-0388	OTHER	NM	LICENSE #

General Provider Information

NPI Number	:	1912000845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY FLORES PTA

Provider Business Mailing Address
First Line	:	1110 W OMAHA ST
Second Line	:	STE 3
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8120
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:	605-721-5940

Provider Business Practice Location Address
First Line	:	3832 E MAIN ST
Second Line	:	STE E
City	:	FARMINGTON
State	:	NM
Zip	:	87402-8749
Country	:	US
Telephone Number	:	505-258-4003
Fax Number	:	505-436-2740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/10/2015

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Directions to “ TONY FLORES PTA” Practice Location

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