# ESPANOLA SPORTS MEDICINE, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Espanola Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982777850
- **Authorized official:** THERESA LYNN GODFREY (SENIOR ACCOUNTANT)
- **Authorized official phone:** (402) 334-1919

## Contact information

- **Practice address:** 708 LA JOYA ST, ESPANOLA, NM 87532-2511
- **Practice address phone:** (505) 753-6550
- **Practice address fax:** (505) 753-1219
- **Mailing address:** 708 LA JOYA ST, ESPANOLA, NM 87532-2511
- **Mailing address phone:** (505) 753-6550
- **Mailing address fax:** (505) 753-1219

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 6628 | NM | — |
| 261QP2000X | Physical Therapy Clinic/Center | 6628 | NM | — |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 10/31/2023