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Individual

MS. GENIA LOUISE DEVENPORT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S. P.T.

Contact information

Practice address
245 E ORCHARD PARK RD, DEXTER, NM 88230-9704
(505) 622-4905
Mailing address
245 E ORCHARD PARK RD, DEXTER, NM 88230-9704
(505) 622-4905

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
396
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
T7398
NM
Enumeration date
03/05/2007
Last updated
07/08/2007
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