Healthcare Provider Details

I. General information

NPI: 1003611369
Provider Name (Legal Business Name): HEALTHY LYMPHATICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 03/17/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 SAN PEDRO DR NE APT A10
ALBUQUERQUE NM
87109-2679
US

IV. Provider business mailing address

4317 SAN PEDRO DR NE APT A10
ALBUQUERQUE NM
87109-2679
US

V. Phone/Fax

Practice location:
  • Phone: 505-307-0082
  • Fax:
Mailing address:
  • Phone: 505-307-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUDY BARKER
Title or Position: OTR
Credential:
Phone: 505-307-0082