Individual
MRS. SHELLEY ELIZABETH MENK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5150 SAN FRANCISCO RD NE, ALBUQUERQUE, NM 87109-4396
(505) 336-7711
(505) 213-2845
Mailing address
11301 MIRAVISTA PL SE, ALBUQUERQUE, NM 87123-6001
(505) 490-1788
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5320
NM
225200000X
Physical Therapy Assistant
A-0862
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-362564-00-6
NEW MEXICO TAXATION AND REVENUE DEPARTMENT BUSINESS REGISTRATION CERTIFICATE
NM
01
—
A-0862
NEW MEXICO PHYSICAL THERAPY BOARD LICENSE
NM
Enumeration date
10/10/2016
Last updated
09/27/2024
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