Healthcare Provider Details

I. General information

NPI: 1639378243
Provider Name (Legal Business Name): MELISSA ELIZABETH ALVERSON L.M.T., CMNTPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8328 WILD DUNES RD NW
ALBUQUERQUE NM
87120-3783
US

IV. Provider business mailing address

8328 WILD DUNES RD NW
ALBUQUERQUE NM
87120-3783
US

V. Phone/Fax

Practice location:
  • Phone: 505-306-4403
  • Fax:
Mailing address:
  • Phone: 505-306-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2679
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: