Provider Demographics
NPI:1669089371
Name:RAEL, BARBARA ANN (PHYSCIAL THERAPIST)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:RAEL
Suffix:
Gender:F
Credentials:PHYSCIAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SUNRANCH VILLAGE LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7795
Mailing Address - Country:US
Mailing Address - Phone:505-361-2111
Mailing Address - Fax:505-407-4486
Practice Address - Street 1:2210 SUNRANCH VILLAGEG LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-361-2111
Practice Address - Fax:505-407-2111
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT2850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1144877218Medicaid
NM1669089371Medicaid