Provider Demographics
NPI:1396814075
Name:MCFALL, MICHAEL L (RPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:MCFALL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2810 HOT SPRINGS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4119
Mailing Address - Country:US
Mailing Address - Phone:505-425-7762
Mailing Address - Fax:505-454-0801
Practice Address - Street 1:932 GALLINAS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3891
Practice Address - Country:US
Practice Address - Phone:505-425-7762
Practice Address - Fax:505-454-0801
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1132174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39185885Medicaid
NM39185885Medicaid