Individual
CHALISA GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1025 MEDICAL ARTS AVE NE, ALBUQUERQUE, NM 87102-2708
(505) 272-9020
Mailing address
1025 MEDICAL ARTS AVE NE, ALBUQUERQUE, NM 87102-2708
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1098
NM
Other
Enumeration date
11/25/2020
Last updated
11/25/2020
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