Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 3361 | NM |
NPI | 1316077969 |
---|---|
Provider Name | Ms. Rose Marie Vallejo |
First Address | Tijeras, NM 87059-7637 |
Second Address | Albuquerque, NM 87102-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |