Provider Demographics
NPI:1093227456
Name:DARREL A ELWELL LLC
Entity Type:Organization
Organization Name:DARREL A ELWELL LLC
Other - Org Name:SUN COUNTRY PHYSICAL THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT MOMT
Authorized Official - Phone:575-625-9020
Mailing Address - Street 1:800 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3004
Mailing Address - Country:US
Mailing Address - Phone:575-625-9020
Mailing Address - Fax:575-625-9025
Practice Address - Street 1:800 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3004
Practice Address - Country:US
Practice Address - Phone:575-625-9020
Practice Address - Fax:575-625-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty