Individual
NANCI WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2670 SCARLET SAGE RD SW, LOS LUNAS, NM 87031-6488
(505) 916-1233
Mailing address
2670 SCARLET SAGE RD SW, LOS LUNAS, NM 87031-6488
(505) 916-1233
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
8567
NM
Other
Enumeration date
01/23/2012
Last updated
07/21/2022
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