Healthcare Provider Details

I. General information

NPI: 1235146432
Provider Name (Legal Business Name): ELLIOT R SHRATTER CMTPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 RIO GRANDE NW SUITE B
ALBUQUERQUE NM
87104-2633
US

IV. Provider business mailing address

1916 GRIEGOS RD NW
ALBUQUERQUE NM
87107-2837
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-4943
  • Fax: 505-265-4986
Mailing address:
  • Phone: 505-344-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: