Healthcare Provider Details

I. General information

NPI: 1245597350
Provider Name (Legal Business Name): FRANKLIN MARVIN MAESTAS LMMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 GRACELAND DR NE
ALBUQUERQUE NM
87110-2956
US

IV. Provider business mailing address

2924 GRACELAND NE
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-6720
  • Fax:
Mailing address:
  • Phone: 505-440-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number7257
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: