Individual
JISELLE BASCOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
200 W 1ST ST STE 527, ROSWELL, NM 88203-4676
(575) 840-3879
(866) 337-2718
Mailing address
PO BOX 8188, ROSWELL, NM 88202-8188
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5713
NM
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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