Provider Demographics
NPI:1932517786
Name:TORRES, JEREMIAS II
Entity Type:Individual
Prefix:
First Name:JEREMIAS
Middle Name:
Last Name:TORRES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BOARDMAN DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4801
Mailing Address - Country:US
Mailing Address - Phone:505-722-9188
Mailing Address - Fax:505-926-0910
Practice Address - Street 1:106 BOARDMAN DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4801
Practice Address - Country:US
Practice Address - Phone:505-722-9188
Practice Address - Fax:505-926-0910
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist