Healthcare Provider Details

I. General information

NPI: 1346949252
Provider Name (Legal Business Name): REBECCA LAUREN MURTHA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 ACADEMY RD NE APT 2124
ALBUQUERQUE NM
87111-7338
US

IV. Provider business mailing address

10700 ACADEMY RD NE APT 2124
ALBUQUERQUE NM
87111-7338
US

V. Phone/Fax

Practice location:
  • Phone: 505-544-6375
  • Fax:
Mailing address:
  • Phone: 505-544-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6885
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: