| |
12 Crestview Drive, Ste 1s, Angel Fire, NM 87710-0489 | |
(575) 377-1900 | |
(575) 377-2383 |
Full Name | |
---|---|
Type | Facility |
Speciality | Physical Therapist - Orthopedic |
Location | 12 Crestview Drive, Angel Fire, New Mexico |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659689347 | NPI | - | NPPES |
43383386 | Medicaid | NM | |
700521047 | Other | NM | MEDICARE GROUP PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2251X0800X | Physical Therapist - Orthopedic | 3072B1 (New Mexico) | Primary |
Mailing Address | Practice Location Address |
---|---|
1398 Weimer Rd, Ste 203, Taos, NM 87571-6397 Ph: (575) 737-0304 | 12 Crestview Drive, Ste 1s, Angel Fire, NM 87710-0489 Ph: (575) 377-1900 |
Aicha Bech Froeschle, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 56 Camino Grande, Angel Fire, NM 87710 Phone: 505-376-2445 |