Healthcare Provider Details

I. General information

NPI: 1669542676
Provider Name (Legal Business Name): HELEN ANN RAYMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 PAN AMERICAN FWY NE STE D
ALBUQUERQUE NM
87107-4793
US

IV. Provider business mailing address

7100 LOUISIANA BLVD NE APT H201
ALBUQUERQUE NM
87109-4772
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4469
  • Fax: 505-889-8142
Mailing address:
  • Phone: 505-888-4469
  • Fax: 505-889-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: