Provider Demographics
NPI:1639062888
Name:MARALIT, LELANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LELANIE
Middle Name:
Last Name:MARALIT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-1258
Mailing Address - Country:US
Mailing Address - Phone:575-214-4926
Mailing Address - Fax:
Practice Address - Street 1:1096 MECHEM DR STE 302A
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7057
Practice Address - Country:US
Practice Address - Phone:575-258-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist