Individual
LISA PETERKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 LEAD AVE SE, ALBUQUERQUE, NM 87108-2844
(505) 266-3655
Mailing address
10908 MALAGUENA LN NE, ALBUQUERQUE, NM 87111-6822
(505) 453-2121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5501
NM
Other
Enumeration date
07/02/2019
Last updated
08/11/2022
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