Individual
GABRIEL SAGE LEWIS-KRAITSIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
104C OLD LAS VEGAS HWY, SANTA FE, NM 87505-9301
(505) 992-4995
Mailing address
626 1/2 ALARID ST, SANTA FE, NM 87505-3042
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5729
NM
Other
Enumeration date
07/05/2020
Last updated
07/05/2020
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