Provider Demographics
NPI:1205934619
Name:TAOS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:TAOS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:575-758-8761
Mailing Address - Street 1:6955 NDCBU
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6498
Mailing Address - Country:US
Mailing Address - Phone:575-758-8761
Mailing Address - Fax:575-751-0448
Practice Address - Street 1:414 SIPAPU STREET
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6498
Practice Address - Country:US
Practice Address - Phone:575-758-8761
Practice Address - Fax:575-751-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN5566Medicaid
NM500521018Medicare ID - Type Unspecified
NM500521018Medicare PIN