Function and Form Physical Therapy LLC
NPI #1124646294 in Santa Teresa, New Mexico
Provider Information
- NPI Number
- 1124646294
- Entity Type
- Organization
- Organization Name
- Function and Form Physical Therapy LLC
- Primary Specialty
- Physical Therapist
- Enumeration Date
- Jul 6, 2020
- Last Updated
- Mar 28, 2021
Practice Location
- Address
- 5312 RIO BRAVO DR STE 7
- City
- Santa Teresa
- State
- New Mexico
- ZIP Code
- 88008-9210
- Phone
- (575) 201-3764
Authorized Official
- Name
- DERRICK DELGADO, PTA
- Title
- MEMBER
- Phone
- (915) 777-1749
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapist |
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