Individual
SHANNON STUYVESANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5123 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87111-2672
(505) 292-3333
Mailing address
5123 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87111-2672
(505) 292-3333
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
A-62
NM
Other
Enumeration date
01/16/2015
Last updated
01/16/2015
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