Organization
SOUTHWEST PHYSICAL & SPORTS THERAPY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROLYN STOKLOSA PT (OWNER/PRESIDENT)
(505) 425-1117
Entity
Organization
Contact information
Practice address
2513 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 425-1117
(505) 454-7810
Mailing address
2513 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 425-1117
(505) 454-7810
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6614
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201079769
PRESBYTERIAN HEALTH
NM
05
—
Q0423
—
NM
Enumeration date
08/03/2006
Last updated
02/06/2012
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