Individual
JULIE R BUSSEWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
700 S BOARDMAN AVE, GALLUP, NM 87301-4707
(505) 721-1172
Mailing address
1612 MONTEREY DR, GALLUP, NM 87301-5640
(505) 721-1172
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
599
NM
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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