Healthcare Provider Details

I. General information

NPI: 1114193893
Provider Name (Legal Business Name): LINDA L MEYER M.T.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1102
US

IV. Provider business mailing address

3714 PIERMONT DR NE
ALBUQUERQUE NM
87111-3455
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-3585
  • Fax: 505-830-3584
Mailing address:
  • Phone: 505-296-5336
  • Fax: 505-830-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1707
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: