Individual
NICOLE MARIE DESOUCHET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
204A W BROADWAY AVE, BLOOMFIELD, NM 87413-5903
(505) 333-7217
(505) 333-7096
Mailing address
204A W BROADWAY AVE, BLOOMFIELD, NM 87413-5903
(505) 333-7217
(505) 333-7096
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5349
NM
Other
Enumeration date
08/13/2018
Last updated
10/25/2018
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