Healthcare Provider Details

I. General information

NPI: 1821266685
Provider Name (Legal Business Name): RELIEF ZONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CHAMA ST NE STE 10
ALBUQUERQUE NM
87108-3595
US

IV. Provider business mailing address

540 CHAMA ST NE STE 10
ALBUQUERQUE NM
87108-3595
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-9663
  • Fax: 505-888-9663
Mailing address:
  • Phone: 505-888-9663
  • Fax: 505-888-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number54853807
License Number StateNM

VIII. Authorized Official

Name: MRS. REBECCA L GRIDER
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 505-888-9663