Individual
MS. JANE E. MERRILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PT
Contact information
Practice address
230 TRUMAN ST NE, ALBUQUERQUE, NM 87108-1333
(505) 268-9506
Mailing address
412 LAFAYETTE PL NE, ALBUQUERQUE, NM 87106-2140
(505) 232-7889
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1210
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1210
PT LICENSE NUMBER
NM
05
—
68339782
—
NM
Enumeration date
02/22/2007
Last updated
07/09/2007
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