Provider Demographics
NPI:1194960591
Name:ALDEA, JOSE MIGUEL (PT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MIGUEL
Last Name:ALDEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 GILA CT
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-8673
Mailing Address - Country:US
Mailing Address - Phone:719-322-3294
Mailing Address - Fax:
Practice Address - Street 1:1510 S SLATE ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-6200
Practice Address - Country:US
Practice Address - Phone:575-544-8669
Practice Address - Fax:575-546-0338
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3492225100000X
TX1057578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist