Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4061 | NM |
NPI | 1003193616 |
---|---|
Provider Name | Roylee Luna |
First Address | Albuquerque, NM 87120-3235 |
Second Address | Albuquerque, NM 87120-3235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2011 |
Last Update Date | 10/11/2011 |