Individual
LAURA LEE BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1751 OLD PECOS TRAIL, SUITE M, SANTA FE, NM 87505
(505) 989-7490
Mailing address
2105 PASEO DEL MONTE, SANTA FE, NM 87501-6320
(505) 982-7783
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1906
NM
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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