Provider Demographics
NPI:1700188851
Name:NEW MEXICO MOBILITY THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:NEW MEXICO MOBILITY THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATP
Authorized Official - Phone:505-944-6431
Mailing Address - Street 1:PO BOX 2033
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-2033
Mailing Address - Country:US
Mailing Address - Phone:505-944-6431
Mailing Address - Fax:505-274-7558
Practice Address - Street 1:31 SHADE TREE LN
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7637
Practice Address - Country:US
Practice Address - Phone:505-944-6431
Practice Address - Fax:505-274-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty