Healthcare Provider Details

I. General information

NPI: 1750419990
Provider Name (Legal Business Name): NANCY ANN KREUTZER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 BALLOON PARK RD NE
ALBUQUERQUE NM
87109-5801
US

IV. Provider business mailing address

7231 COPPER GRASS CT NE
ALBUQUERQUE NM
87113-2082
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-6370
  • Fax:
Mailing address:
  • Phone: 505-480-7197
  • Fax: 505-797-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1854
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: