Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 235 | NM |
Y | 2251P0200X | Physical Therapist - Pediatrics | 235 | NM |
NPI | 1487825030 |
---|---|
Provider Name | Mrs. Karen Grimm Lucero |
First Address | Albuquerque, NM 87107-1614 |
Second Address | Albuquerque, NM 87107-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2008 |
Last Update Date | 21/03/2008 |