Provider Demographics
NPI:1912000845
Name:FLORES, TONY (PTA)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1110 W OMAHA ST
Mailing Address - Street 2:STE 3
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8120
Mailing Address - Country:US
Mailing Address - Phone:605-721-5950
Mailing Address - Fax:605-721-5940
Practice Address - Street 1:3832 E MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8749
Practice Address - Country:US
Practice Address - Phone:505-258-4003
Practice Address - Fax:505-436-2740
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA-0388OtherLICENSE #