Individual
MISS BETHANY D COBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
11517 HANNETT AVE NE, ALBUQUERQUE, NM 87112-4413
(505) 417-4167
Mailing address
11517 HANNETT AVE NE, ALBUQUERQUE, NM 87112-4413
(505) 417-4167
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3769
NM
Other
Enumeration date
05/20/2008
Last updated
12/07/2016
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