Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4563 | NM |
N | 2251N0400X | Physical Therapist - Neurology | 1199288 | TX |
NPI | 1568881621 |
---|---|
Provider Name | Melissa Moriel |
First Address | Las Cruces, NM 88005-3248 |
Second Address | Las Cruces, NM 88005-6502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 27/01/2017 |