Individual
GLENDA CLEMMER BLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, RMT
Contact information
Practice address
2905 N PRINCE ST, SUITE C, CLOVIS, NM 88101-3843
(505) 763-0551
Mailing address
PO BOX 784, FARWELL, TX 79325-0784
(806) 481-8181
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3498
NM
225700000X
Massage Therapist
MT022683
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM00RE56
BLUE CROSS & BLUE SHIELD
NM
Enumeration date
01/22/2007
Last updated
07/08/2007
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