Individual
JACK EVANS LOER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
9412 INDIAN SCHOOL RD NE, ALBUQUERQUE, NM 87112-2878
(505) 553-5887
Mailing address
9811 DESERT MOUNTAIN RD NE, ALBUQUERQUE, NM 87122-3927
(505) 828-3448
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5579
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5579
LMT LICENSE NUMBER
NM
Enumeration date
09/27/2007
Last updated
09/27/2007
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