Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 600 | NM |
N | 2251P0200X | Physical Therapist - Pediatrics | 600 | NM |
NPI | 1013216746 |
---|---|
Provider Name | Rebecca Maidment |
First Address | Albuquerque, NM 87109-5021 |
Second Address | Albuquerque, NM 87109-5021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2011 |
Last Update Date | 21/03/2011 |