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Organization
ESPANOLA SPORTS MEDICINE, PA
Active
Organization
ESPANOLA SPORTS MEDICINE, PA
Active
Other names
Espanola Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA LYNN GODFREY (SENIOR ACCOUNTANT)
(402) 334-1919
Entity
Organization
Contact information
Practice address
708 LA JOYA ST, ESPANOLA, NM 87532-2511
(505) 753-6550
(505) 753-1219
Mailing address
708 LA JOYA ST, ESPANOLA, NM 87532-2511
(505) 753-6550
(505) 753-1219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6628
NM
261QP2000X
Physical Therapy Clinic/Center
6628
NM
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
11/16/2006
Last updated
10/31/2023
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