Healthcare Provider Details

I. General information

NPI: 1689160590
Provider Name (Legal Business Name): THERESA CHRISTINE URIAS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORNELL DR SE BLDG 73
ALBUQUERQUE NM
87131-4950
US

IV. Provider business mailing address

1025 JIMENEZ DR
CHAPARRAL NM
88081-7659
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 915-330-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8689
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT127880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: