Individual
MARY GROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2610 TRINITY DR STE 16, LOS ALAMOS, NM 87544-2374
(505) 551-0523
(505) 570-4640
Mailing address
147 TAOS ST, LOS ALAMOS, NM 87544-2637
(575) 518-9039
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1372
NM
Other
Enumeration date
12/22/2023
Last updated
12/22/2023
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