Individual
MR. CARL HEINZ LAITENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1000 E AZTEC AVE, GALLUP, NM 87301-5509
(505) 721-1812
Mailing address
1018 E MESA AVE, GALLUP, NM 87301-5447
(505) 863-3134
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3044
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25288822
—
NM
Enumeration date
03/23/2007
Last updated
07/08/2007
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