Healthcare Provider Details

I. General information

NPI: 1447508932
Provider Name (Legal Business Name): LORI JEAN HEALY L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10126 COORS BLVD NW
ALBUQUERQUE NM
87114-4022
US

IV. Provider business mailing address

771 SUNFLOWER DR SW
RIO RANCHO NM
87124-4220
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-5557
  • Fax:
Mailing address:
  • Phone: 505-249-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5717
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: