Provider Demographics
NPI:1407268923
Name:LA LUZ THERAPIES LLC
Entity Type:Organization
Organization Name:LA LUZ THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LELAND-HEINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:575-770-7078
Mailing Address - Street 1:1337 GUSDORF RD STE G
Mailing Address - Street 2:SUITE G
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6297
Mailing Address - Country:US
Mailing Address - Phone:575-758-4337
Mailing Address - Fax:575-751-1890
Practice Address - Street 1:1337 GUSDORF RD STE G
Practice Address - Street 2:SUITE G
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6297
Practice Address - Country:US
Practice Address - Phone:575-758-4337
Practice Address - Fax:575-751-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM612261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy