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Individual

STEPHANIE L BACA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
1612 RIDGECREST DR SE, ALBUQUERQUE, NM 87108-4437
(505) 250-7049
Mailing address
1612 RIDGECREST DR SE, ALBUQUERQUE, NM 87108-4437
(505) 250-7049

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3533
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000Q0406
NM
01
1386651412
BILLING NPI
NM
Enumeration date
08/06/2009
Last updated
12/02/2021
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