Individual
STEVE P. WAGHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT,MS
Contact information
Practice address
535 HIGHWAY 314 SW, LOS LUNAS, NM 87031-9600
(505) 866-0055
Mailing address
535 HIGHWAY 314 SW, LOS LUNAS, NM 87031-9600
(505) 866-0055
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3129
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000Q0406
MEDICAID GROUP #
NM
01
—
1245380039
BERNALILLO FACILITY NPI
NM
01
—
1356491146
BELEN FACILITY NPI
NM
01
—
1386651412
LOS LUNAS FACILITY NPI
NM
01
—
3129
NM STATE LICENSE
NM
05
—
33607851
—
NM
01
—
P00253827
RAILROAD MEDICARE
NM
Enumeration date
07/26/2006
Last updated
04/19/2010
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