Provider Demographics
NPI:1902495740
Name:EAGLEDOVE PHYSICAL THERAPY 7 MASSAGE
Entity Type:Organization
Organization Name:EAGLEDOVE PHYSICAL THERAPY 7 MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:157-559-0233
Mailing Address - Street 1:3868 CALLE ARRIBA
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7934
Mailing Address - Country:US
Mailing Address - Phone:157-559-0233
Mailing Address - Fax:
Practice Address - Street 1:3868 CALLE ARRIBA
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7934
Practice Address - Country:US
Practice Address - Phone:157-559-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty