Individual
BENJAMIN LOISELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8616 MENAUL BLVD NE STE A, ALBUQUERQUE, NM 87112-2262
(505) 292-4784
Mailing address
3901 INDIAN SCHOOL RD NE APT B403, ALBUQUERQUE, NM 87110-3867
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PT-2024-0175
NM
Other
Enumeration date
06/07/2024
Last updated
06/07/2024
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