Organization
SOUTHWEST MYOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN P. CARBONNEAU (OFFICE MANAGER)
(505) 830-3585
Entity
Organization
Contact information
Practice address
4103 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1102
(505) 830-3585
(505) 830-3584
Mailing address
4103 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1102
(505) 830-3585
(505) 830-3584
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
1707
NM
225700000X
Massage Therapist
Primary
4024
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114193893
NPI
NM
01
—
1972650224
NPI
NM
Enumeration date
10/21/2008
Last updated
10/21/2008
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