Healthcare Provider Details

I. General information

NPI: 1104526631
Provider Name (Legal Business Name): THOMAS DANIEL SABO LMT #4266
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLE ST SE
ALBUQUERQUE NM
87106-4826
US

IV. Provider business mailing address

PO BOX 8037
SANTA FE NM
87504-8037
US

V. Phone/Fax

Practice location:
  • Phone: 505-316-5119
  • Fax:
Mailing address:
  • Phone: 505-316-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: