Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7573 | NM |
NPI | 1003241761 |
---|---|
Provider Name | Mr. Stephen Anthony Martinez |
First Address | Albuquerque, NM 87114-6111 |
Second Address | Albuquerque, NM 87114-6111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2013 |
Last Update Date | 12/09/2013 |