Healthcare Provider Details

I. General information

NPI: 1013780329
Provider Name (Legal Business Name): LEAH M TELLES LMT8261
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 JEFFERSON ST NE
ALBUQUERQUE NM
87109-3489
US

IV. Provider business mailing address

5239 GOLD RUSH DR NW
ALBUQUERQUE NM
87120-2816
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-7464
  • Fax:
Mailing address:
  • Phone: 505-369-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8261
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: