Individual
KENYAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1640 OLD PECOS TRL STE E, SANTA FE, NM 87505-4777
(561) 843-4380
Mailing address
2934 CALLE DEL RES, SANTA FE, NM 87505-6716
(561) 843-4380
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT9637
NM
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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