Healthcare Provider Details
I. General information
NPI: 1013375252
Provider Name (Legal Business Name): MRS. CYNTHIA WILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/02/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US
IV. Provider business mailing address
3028 ZIA ST NE
RIO RANCHO NM
87144-5344
US
V. Phone/Fax
- Phone: 505-243-2257
- Fax:
- Phone: 505-401-9972
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225200000X |
| Taxonomy | Physical Therapy Assistant |
| License Number | A-1193 |
| License Number State | NM |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: