Individual
SUSAN WORTHINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
5 COUNTY RD. 179, OJO CALIENTE, NM 87549
(505) 927-1101
Mailing address
PO BOX 88, 5 COUNTY RD. 179, OJO CALIENTE, NM 87549-0088
(505) 927-1101
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1566
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1566
PT LICENSE
NM
01
—
59251026
DD WAIVER PROVIDER NUMBER
NM
05
—
Z0845
—
NM
Enumeration date
01/08/2007
Last updated
07/09/2007
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