Healthcare Provider Details

I. General information

NPI: 1023129632
Provider Name (Legal Business Name): SANDRA LEE HUSSEY LMT CNMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: S L LEANDRA HUSSEY LMT CNMT

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE SUITE C5
ALBUQUERQUE NM
87110-8900
US

IV. Provider business mailing address

1044 SANDIA VISTA RD NE
RIO RANCHO NM
87144-5160
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-2279
  • Fax: 505-891-8637
Mailing address:
  • Phone: 505-304-2279
  • Fax: 505-891-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2815
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: