Healthcare Provider Details

I. General information

NPI: 1285780510
Provider Name (Legal Business Name): CHRISTINA LUISA CALVIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 CHAVEZ RD NW
ALBUQUERQUE NM
87107-5600
US

IV. Provider business mailing address

733 CHAVEZ RD NW
ALBUQUERQUE NM
87107-5600
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-7677
  • Fax: 505-343-1823
Mailing address:
  • Phone: 505-345-7677
  • Fax: 505-343-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number354
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: