Provider Demographics
NPI:1811395387
Name:DESIRE.SANTE, LLC
Entity Type:Organization
Organization Name:DESIRE.SANTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:575-556-8440
Mailing Address - Street 1:2455 MISSOURI AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5122
Mailing Address - Country:US
Mailing Address - Phone:575-556-8440
Mailing Address - Fax:575-556-8439
Practice Address - Street 1:2455 MISSOURI AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5122
Practice Address - Country:US
Practice Address - Phone:575-556-8440
Practice Address - Fax:575-556-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty