Healthcare Provider Details

I. General information

NPI: 1497043848
Provider Name (Legal Business Name): CAROLYN DENISE EIFERT LMT, CMTPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN DENISE COLE LMT, CMTPT

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 MIRACERROS PLACE NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

1813 MIRACERROS PLACE NE
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-449-7230
  • Fax: 877-812-7771
Mailing address:
  • Phone: 505-449-7230
  • Fax: 877-812-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6273
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: