Healthcare Provider Details

I. General information

NPI: 1659656239
Provider Name (Legal Business Name): ANTHONY DAVID ROBINSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CENTRAL AVE NW SUITE E
ALBUQUERQUE NM
87102-3437
US

IV. Provider business mailing address

315 CENTRAL AVE NW SUITE E
ALBUQUERQUE NM
87102-3437
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-3586
  • Fax:
Mailing address:
  • Phone: 505-321-3586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6734
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: