Individual
TINA BENALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT
Contact information
Practice address
3501 N BUTLER AVE, STE 101& 102, FARMINGTON, NM 87401-6429
(505) 326-0064
(505) 327-3995
Mailing address
3501 N BUTLER AVE, STE 101& 102, FARMINGTON, NM 87401-6429
(505) 326-0064
(505) 327-3995
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
448
NM
Other
Enumeration date
03/04/2009
Last updated
03/04/2009
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