Healthcare Provider Details

I. General information

NPI: 1255487906
Provider Name (Legal Business Name): MICHELLE R VERMETTE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7104 CALLE MONTANA NE
ALBUQUERQUE NM
87113-1276
US

IV. Provider business mailing address

7104 CALLE MONTANA NE
ALBUQUERQUE NM
87113-1276
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-3424
  • Fax: 505-344-3424
Mailing address:
  • Phone: 505-344-3424
  • Fax: 505-344-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2614
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: