Provider Demographics
NPI:1205981339
Name:REHABILITATION & OCCUPATIONAL MEDICINE LLC
Entity type:Organization
Organization Name:REHABILITATION & OCCUPATIONAL MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DELAHOUSSAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-532-6054
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1420
Mailing Address - Country:US
Mailing Address - Phone:575-532-6054
Mailing Address - Fax:575-532-0215
Practice Address - Street 1:3530 FOOTHILLS RD
Practice Address - Street 2:SUITE N
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3626
Practice Address - Country:US
Practice Address - Phone:575-532-6054
Practice Address - Fax:575-532-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-180208100000X, 207Q00000X
NM2000-1862085R0202X
NM1661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty