Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4130 | NM |
NPI | 1003258062 |
---|---|
Provider Name | Mrs. Lana C Ramos |
First Address | Clayton, NM 88415-3339 |
Second Address | Clayton, NM 88415-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 19/07/2013 |