Provider Demographics
NPI:1982610580
Name:MONTES, CARLOS RAFAEL (MPT)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:RAFAEL
Last Name:MONTES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 EXCALIBUR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1201
Mailing Address - Country:US
Mailing Address - Phone:915-329-8703
Mailing Address - Fax:
Practice Address - Street 1:5055 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9442
Practice Address - Country:US
Practice Address - Phone:505-589-5005
Practice Address - Fax:505-589-1333
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156893225100000X
NM3156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ59309Medicare UPIN