Provider Demographics
NPI:1720181506
Name:ESPARZA, ALICIA B (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:B
Last Name:ESPARZA
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 1:6955 NDCBU
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6242
Mailing Address - Country:US
Mailing Address - Phone:575-758-8761
Mailing Address - Fax:575-758-8761
Practice Address - Street 1:414 SIPAPU ST
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:575-758-8761
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM300561Medicare PIN