MEDICARE: DONNA LYNN ROLLAND-LOVATO LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	4367	NM

General Provider Information

NPI Number	:	1255342218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA LYNN ROLLAND-LOVATO LMT

Provider Business Mailing Address
First Line	:	5301 PURCELL DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1920
Country	:	US
Telephone Number	:	505-688-8237
Fax Number	:	505-881-5207

Provider Business Practice Location Address
First Line	:	201 EUBANK BLVD NE
Second Line	:	STE. A3
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-2759
Country	:	US
Telephone Number	:	505-688-8237
Fax Number	:	505-881-5207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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