Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 453 | NM |
N | 225100000X | Physical Therapist | 2858 | NM |
NPI | 1053422956 |
---|---|
Provider Name | Kathleen A Alcon |
First Address | Taos, NM 87571 |
Second Address | Taos, NM 87571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 27/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43383386 | (05) | NM |
900521043 | (02) | NM |