Individual
MS. LISA L LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
2709 WYOMING BLVD NE, ALBUQUERQUE, NM 87111-4540
(505) 294-5486
Mailing address
2403 SAN MATEO BLVD NE, W-16, ALBUQUERQUE, NM 87110-4058
(505) 363-6718
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4655
NM
Other
Enumeration date
01/05/2011
Last updated
01/05/2011
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