Organization
OUTLAST THERAPEUTICS LTD. CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANI MCCOY (OWNER)
(505) 967-6901
Entity
Organization
Contact information
Practice address
6211 SAN MATEO BLVD NE STE 200, ALBUQUERQUE, NM 87109-3534
(505) 373-2833
Mailing address
6104 MARTA RD NW, ALBUQUERQUE, NM 87114-3897
(505) 967-6901
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
10/24/2018
Last updated
10/24/2018
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