Individual
GORDON HENRIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1607 W AZTEC BLVD, AZTEC, NM 87410-1805
(505) 334-3695
Mailing address
2006 EASTLAWN AVE, DURANGO, CO 81301-4835
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2498
NM
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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