Individual
NICOLE MARIE REDWINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4617 BISMARK HILLS WAY NE, RIO RANCHO, NM 87144-8608
(505) 315-9649
Mailing address
4617 BISMARK HILLS WAY NE, RIO RANCHO, NM 87144-8608
(505) 315-9649
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1936
NM
Other
Enumeration date
04/15/2022
Last updated
04/15/2022
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