| |
708 La Joya St, Espanola, NM 87532-2511 | |
(505) 753-6550 | |
(505) 753-1219 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Rehabilitation |
Location | 708 La Joya St, Espanola, New Mexico |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1982777850 | NPI | - | NPPES |
R5803 | Medicaid | NM |
Provider Name | Marian C Bradbury |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1942324900 PECOS PAC ID: 6507188216 Enrollment ID: I20141209000669 |
Provider Name | Amanda R Vander Wiel |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1700449931 PECOS PAC ID: 4082030150 Enrollment ID: I20200819003469 |
Provider Name | Tara Terrazas |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1891562674 PECOS PAC ID: 6002268273 Enrollment ID: I20240124000031 |
Provider Name | Adriana A Hernandez |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1225498116 PECOS PAC ID: 7113224635 Enrollment ID: I20240725004533 |
Provider Name | Jay-paul Thornburg |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1447674379 PECOS PAC ID: 3577879857 Enrollment ID: I20240822004458 |
Mailing Address | Practice Location Address |
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708 La Joya St, Espanola, NM 87532-2511 Ph: (505) 753-6550 | 708 La Joya St, Espanola, NM 87532-2511 Ph: (505) 753-6550 |