Function and Form Physical Therapy LLC
Organization Active NPI Physical Therapist · Santa Teresa, NM
NPI 1124646294 · NPPES record last updated Mar 28, 2021
Key facts
- NPI
- 1124646294
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- FUNCTION AND FORM PHYSICAL THERAPY LLC
- Practice address
- 5312 Rio Bravo Dr Ste 7
Santa Teresa, NM 88008-9210 - Phone
- (575) 201-3764
- NPI assigned
- Jul 6, 2020
- Organization subpart
- No
Authorized official
- Name
- Derrick Delgado, PTA
- Title
- Member
- Phone
- (915) 777-1749
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
5312 Rio Bravo Dr Ste 7
Santa Teresa, NM 88008-9210
Mailing address
5312 Rio Bravo Dr Ste 7
Santa Teresa, NM 88008-9210
Phone (575) 201-3764
Other providers in Santa Teresa, NM
- Andrea Flores
- Diana Flores
- Gabriel Fontan
- Marilyn Niomie Fraga
- Maria Adelina Frisbie-Veal
- Gadsden Independent School District
- Ennis Andrea Galaz
- Nicolette Cristina Gallegos
- Eveline Garcia
- Ramon Alberto Gaspar
All providers in Santa Teresa, NM · Physical Therapist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.