Physical Therapy & Sports Medicine of Northern New Mexico, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1025 Issued in NM

Legal business name

PHYSICAL THERAPY & SPORTS MEDICINE OF NORTHERN NEW MEXICO, INC.

Practice address

505 N Main Ave
Aztec, NM 87410-1942

Phone

(505) 334-9616

Fax

(505) 334-7343

NPI assigned

Apr 10, 2007

Last updated

Oct 7, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sid Mosiman, PTNPI 1871667089

Title

Director

Phone

(505) 334-9616

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sid Mosiman, PT

  • Physical Therapist
  • Aztec, NM
  • NPI 1871667089
  Medicare reassignment Care Compare group Authorized official
• Carson Jay Collins

  • Physical Therapist
  • Aztec, NM
  • NPI 1821953324
  Medicare reassignment Care Compare group NPD
• Matthew Vidal Fernandez, PT

  • Physical Therapist
  • Aztec, NM
  • NPI 1851001077
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759795200000",
    "number": "1306069224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N MAIN AVE",
            "city": "AZTEC",
            "state": "NM",
            "postal_code": "874101942",
            "telephone_number": "505-334-9616",
            "fax_number": "505-334-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N MAIN AVE",
            "city": "AZTEC",
            "state": "NM",
            "postal_code": "874101942",
            "telephone_number": "505-334-9616",
            "fax_number": "505-334-7343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "660 E Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Bloomfield",
            "state": "NM",
            "postal_code": "874136601",
            "country_code": "US",
            "telephone_number": "505-632-4550",
            "fax_number": "505-632-3387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICAL THERAPY & SPORTS MEDICINE OF NORTHERN NEW MEXICO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "MOSIMAN",
        "authorized_official_first_name": "SID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "505-334-9616",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "1025",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NM",
            "license": "A-0483",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NM",
            "license": "108",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lissa Ellen Paak, OT
• Susie Palmer
• Douglas D. Parks, D.D.S.
• Elvira Payton
• Katrina Perfect
• Bryan Standley Poe, DO
• Kathleen A Price
• Jonathon Qualls, D.C.
• Tonnya Redmond, OTR
• Jorge Rodriguez, COTA/L

• Physical Therapist in Aztec, NM
• Providers in Aztec, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.