Individual
CAROLYN D. BENALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1430 SAN CARLOS RD SW, ALBUQUERQUE, NM 87104-1041
(505) 553-1093
Mailing address
1430 SAN CARLOS RD SW, ALBUQUERQUE, NM 87104-1041
(505) 553-1093
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-0436
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-0436
PT LICENSURE
NM
Enumeration date
01/01/2008
Last updated
01/01/2008
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