MEDICARE: MS. LEANNE LOUISE CHATTEY CTP

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	261QP2000X	Physical Therapy Clinic/Center		NM

General Provider Information

NPI Number	:	1922363597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEANNE LOUISE CHATTEY CTP

Provider Business Mailing Address
First Line	:	1 BRIMHALL WASH
Second Line	:
City	:	SANTE FE
State	:	NM
Zip	:	87508
Country	:	US
Telephone Number	:	505-795-4354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 RODEO PARK DR E BLDG 3
Second Line	:	SANTE FE SOUL HEALTH AND HEALING CENTER
City	:	SANTA FE
State	:	NM
Zip	:	87505-6313
Country	:	US
Telephone Number	:	505-474-8885
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/13/2012

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