Provider Demographics
NPI:1043006893
Name:DESERT GRACE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DESERT GRACE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:575-607-5371
Mailing Address - Street 1:1270 HOLLIS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88435-3715
Mailing Address - Country:US
Mailing Address - Phone:575-607-5371
Mailing Address - Fax:
Practice Address - Street 1:210 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:NM
Practice Address - Zip Code:88435-2313
Practice Address - Country:US
Practice Address - Phone:575-607-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy