Organization
CUATITAS PHYSICAL & SPORTS THERAPY
Active
Organization
CUATITAS PHYSICAL & SPORTS THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO J LUCERO (MANAGER/OWNER)
(505) 715-3451
Entity
Organization
Contact information
Practice address
2503 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 454-1078
(505) 454-1164
Mailing address
519 VEGAS DR, LAS VEGAS, NM 87701-4690
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3441
NM
Other
Enumeration date
11/05/2012
Last updated
05/29/2019
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