Provider Demographics
NPI:1578650933
Name:MARES, FELIPE J (PT)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:J
Last Name:MARES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811C HARDWARE DR NE
Mailing Address - Street 2:STE 3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2019
Mailing Address - Country:US
Mailing Address - Phone:505-884-4609
Mailing Address - Fax:505-884-4015
Practice Address - Street 1:4811 HARDWARE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2017
Practice Address - Country:US
Practice Address - Phone:505-884-4609
Practice Address - Fax:505-884-4015
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist