Healthcare Provider Details

I. General information

NPI: 1003241092
Provider Name (Legal Business Name): DAPHNE THAYER BARRETT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 MONTGOMERY BLVD NE SUITE 200
ALBUQUERQUE NM
87109-6747
US

IV. Provider business mailing address

901 ORTEGA RD NW
LOS RANCHOS NM
87114-1417
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-3100
  • Fax:
Mailing address:
  • Phone: 505-263-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number7312
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: