Active NPI
Ravelle A Smoor-Kolloffel, PT
- Physical Therapist
- Las Cruces, NM
National Provider Identifier
1306908876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2071
- Practice address
- 2455 E.Missouri
Suite B
Las Cruces, NM 88001-5122 - Phone
- (575) 556-8440
- Fax
- (575) 556-8439
- NPI assigned
- Dec 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2071 | NM | Primary |
Addresses
Primary practice location
2455 E.Missouri
Suite B
Las Cruces, NM 88001-5122
Mailing address
2455 Missouri Ave
Suite B
Las Cruces, NM 88001-5122
Phone (505) 556-8440
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM00Q485 | Other | NM | BLUE CROSS BLUE SHIELD |
| 32752750 | Medicaid | NM |
Other names 1
- Ravelle A Smoor
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2071 | NM | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Real View Diagnostics LLC | Physical Therapist | Past | Accepting new patients |
| Southwest Sport and Spine Center Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Las Cruces, NM
- NPI 1164475208
-
- Physical Therapist
- Canutillo, TX
- NPI 1336882026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430956800000",
"number": "1306908876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2455 MISSOURI AVE",
"address_2": "SUITE B",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880015122",
"telephone_number": "505-556-8440",
"fax_number": "575-556-8439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2455 E.MISSOURI",
"address_2": "SUITE B",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880015122",
"telephone_number": "575-556-8440",
"fax_number": "575-556-8439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMOOR-KOLLOFFEL",
"first_name": "RAVELLE",
"middle_name": "A",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-14",
"last_updated": "2015-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "2071",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "NM00Q485",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32752750",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "RAVELLE",
"last_name": "SMOOR",
"middle_name": "A",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.