Provider Demographics
NPI:1588859268
Name:ARONOVITZ, TERESA L (MSPT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:ARONOVITZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 WEIMER RD
Mailing Address - Street 2:STE 203
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6397
Mailing Address - Country:US
Mailing Address - Phone:575-737-0304
Mailing Address - Fax:575-737-0383
Practice Address - Street 1:1398 WEIMER RD
Practice Address - Street 2:STE 203
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6397
Practice Address - Country:US
Practice Address - Phone:575-737-0304
Practice Address - Fax:575-737-0383
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6890225100000X
NM4264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43383386Medicaid
NM43383386Medicaid
CO840614901OtherTIN