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Individual

SANDRA J WISE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
6500 HOOCHANEETSA BLVD, COCHITI LAKE, NM 87083-6030
(505) 465-0241
Mailing address
6500 HOOCHANEETSA BLVD, COCHITI LAKE, NM 87083-6030
(505) 465-0241

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
6769
NM

Other

Enumeration date
12/15/2010
Last updated
12/15/2010
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