Organization
FUNCTION AND FORM PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK DELGADO PTA (MEMBER)
(915) 777-1749
Entity
Organization
Contact information
Practice address
5312 RIO BRAVO DR STE 7, SANTA TERESA, NM 88008-9210
(575) 201-3764
Mailing address
5312 RIO BRAVO DR STE 7, SANTA TERESA, NM 88008-9210
(575) 201-3764
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/06/2020
Last updated
03/28/2021
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