Healthcare Provider Details

I. General information

NPI: 1700153251
Provider Name (Legal Business Name): LIMA KAI MASSAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 3RD ST NW SUITE #67
ALBUQUERQUE NM
87102-3334
US

IV. Provider business mailing address

200 3RD ST NW SUITE #67
ALBUQUERQUE NM
87102-3334
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-1469
  • Fax:
Mailing address:
  • Phone: 505-247-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6323
License Number StateNM

VIII. Authorized Official

Name: MRS. KARA LYNN DEYHLE
Title or Position: OWNER
Credential: LMT
Phone: 505-247-1469