Healthcare Provider Details

I. General information

NPI: 1366371080
Provider Name (Legal Business Name): DYANNA PRESTWICH MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1648
US

IV. Provider business mailing address

7601 JACOBO DR NE
ALBUQUERQUE NM
87109-6463
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-6283
  • Fax:
Mailing address:
  • Phone: 505-263-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2026-0087
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: