Organization
ESPANOLA SPORTS MEDICINE, PA
Active
Other names
Espanola Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA LYNN GODFREY (SENIOR ACCOUNTANT)
(402) 334-1919
Entity
Organization
Contact information
Practice address
708 LA JOYA ST, ESPANOLA, NM 87532-2511
(505) 753-6550
(505) 753-1219
Mailing address
708 LA JOYA ST, ESPANOLA, NM 87532-2511
(505) 753-6550
(505) 753-1219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6628
NM
261QP2000X
Physical Therapy Clinic/Center
6628
NM
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R5803
—
NM
Enumeration date
11/16/2006
Last updated
10/31/2023
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