Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1119200 |
NPI | 1124359849 |
---|---|
Provider Name | Ms. Celeste Loveland O'neill |
First Address | Albuquerque, NM 87112-1438 |
Second Address | Albuquerque, NM 87112-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2010 |
Last Update Date | 20/01/2010 |