Provider Demographics
NPI:1588819171
Name:COUNTERPOISE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COUNTERPOISE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:602-318-9401
Mailing Address - Street 1:PO BOX 53191
Mailing Address - Street 2:
Mailing Address - City:PINOS ALTOS
Mailing Address - State:NM
Mailing Address - Zip Code:88053-3191
Mailing Address - Country:US
Mailing Address - Phone:620-318-9401
Mailing Address - Fax:
Practice Address - Street 1:1609 SILVER HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5643
Practice Address - Country:US
Practice Address - Phone:602-318-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3465261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy