Provider Demographics
NPI:1508843558
Name:MORNING LIGHT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MORNING LIGHT PHYSICAL THERAPY INC
Other - Org Name:MORNING LIGHT PHYSICAL THERAPY FOR WOMEN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALCON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-751-9500
Mailing Address - Street 1:1350 PASEO DEL PUEBLO SUR
Mailing Address - Street 2:STE A
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5962
Mailing Address - Country:US
Mailing Address - Phone:505-751-9500
Mailing Address - Fax:505-751-3013
Practice Address - Street 1:1350 PASEO DEL PUEBLO SUR
Practice Address - Street 2:STE A
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5962
Practice Address - Country:US
Practice Address - Phone:505-751-9500
Practice Address - Fax:505-751-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy