Individual
ALYSS FILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7900 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110-7513
(505) 296-5565
(402) 895-7812
Mailing address
13609 CALIFORNIA ST STE 200, OMAHA, NE 68154-5245
(585) 780-0456
(402) 895-7812
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
0013799
CO
225200000X
Physical Therapy Assistant
Primary
PTA1631
NM
Other
Enumeration date
03/17/2016
Last updated
12/30/2024
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