Healthcare Provider Details

I. General information

NPI: 1598265852
Provider Name (Legal Business Name): ERICA LANNON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RIM RD
ARROYO SECO NM
87514
US

IV. Provider business mailing address

PO BOX 3692
TAOS NM
87571-3692
US

V. Phone/Fax

Practice location:
  • Phone: 575-779-0268
  • Fax:
Mailing address:
  • Phone: 575-779-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number5914
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: