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Individual

DWAYNE MACIAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
510 W MALONEY AVE, GALLUP, NM 87301-5489
(505) 488-2620
(505) 488-2668
Mailing address
15 APEX DR, HIGHLAND, IL 62249-1282
(618) 651-0444
(618) 441-0482

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1619
NM

Other

Enumeration date
08/18/2016
Last updated
08/18/2016
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