Individual
DANA M WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1129 MECHEM DR STE C, RUIDOSO, NM 88345-7292
(575) 808-8721
(575) 808-8723
Mailing address
125 VISTA RIO BONITO DR, ALTO, NM 88312-9400
(575) 808-8721
(575) 808-8723
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1087419
TX
225100000X
Physical Therapist
3987
NM
225100000X
Physical Therapist
Primary
PT3987
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12757349
—
NM
Enumeration date
12/31/2008
Last updated
04/30/2021
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