Basic Information
| Provider Information | |||||||||
| NPI: | 1871688184 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEL VALLE PHYSICAL THERAPY AND REHABILITATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DEL VALLE PT AND REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 MISSOURI AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880015111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055238080 | ||||||||
| FaxNumber: | 5055238861 | ||||||||
| Practice Location | |||||||||
| Address1: | 2445 MISSOURI AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880015111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755238080 | ||||||||
| FaxNumber: | 5755238861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | FIGUEROA | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5755238080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 2251X0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 1724 | 01 | NM | LOVELACE HEALTH PLAN | OTHER | 53226003 | 05 | NM | MEDICAID | NM00NA65 | 01 | NM | BLUE CROSS BLUE SHIELD | OTHER | 10524 | 01 | NM | PRESBYTERIAN HEALTH PLAN | OTHER | PROVA41159 | 01 | NM | MOLINA HEALTH PLAN | OTHER |