Provider Demographics
NPI:1912922808
Name:SACASA, OLGA M (PT)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:M
Last Name:SACASA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 US HIGHWAY 314, SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031
Mailing Address - Country:US
Mailing Address - Phone:505-861-1200
Mailing Address - Fax:505-861-1220
Practice Address - Street 1:535 US HIGHWAY 314, SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-861-1200
Practice Address - Fax:505-861-1220
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82487022Medicaid
NM000Q0406Medicaid
NM1356491146OtherBELEN FACILITY NPI
NM1386651412OtherLOS LUNAS FACILITY NPI
NM1245380039OtherBERNALILLO FACILITY NPI
NM2549OtherNM STATE LICENSE
NMP00348973OtherRAILROAD MEDICARE
NM82487022Medicaid
NMP00348973OtherRAILROAD MEDICARE