Healthcare Provider Details

I. General information

NPI: 1609280536
Provider Name (Legal Business Name): KARRI HAUSER MMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 WYOMING BLVD NE SUITE C
ALBUQUERQUE NM
87109-3132
US

IV. Provider business mailing address

6428 PEPPERDINE ST NE
ALBUQUERQUE NM
87111-1216
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-7203
  • Fax:
Mailing address:
  • Phone: 505-350-7203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7742
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: