Individual
AMY J LEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1604 W 18TH ST, PORTALES, NM 88130-7097
(575) 359-4719
Mailing address
1001 PECOS ST, CLOVIS, NM 88101-5187
(575) 799-5375
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1403
NM
Other
Enumeration date
05/25/2017
Last updated
05/25/2017
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