Individual
JAKE THEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
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
PT-2024-0157
NM
Other
Enumeration date
06/12/2024
Last updated
06/17/2024
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