Provider Demographics
NPI:1295792828
Name:READY, MARCIA L (PT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:READY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 WEIMER RD
Mailing Address - Street 2:STE 203
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-737-0304
Mailing Address - Fax:505-737-0383
Practice Address - Street 1:1398 WEIMER ROAD
Practice Address - Street 2:STE 203
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-737-0304
Practice Address - Fax:505-737-0383
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-10-16
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-10-16
Provider Licenses
StateLicense IDTaxonomies
NMNM886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01NA02OtherBCBS OF NEW MEXICO
NM43383386Medicaid