Individual
ADELINE CLEVELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
618 PASEO DE PERALTA STE A, SANTA FE, NM 87501-1984
(505) 989-1818
Mailing address
PO BOX 493, TESUQUE, NM 87574-0493
(802) 989-8067
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT9402
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT9402
LMT LICENSE
NM
Enumeration date
10/12/2021
Last updated
10/12/2021
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