Healthcare Provider Details

I. General information

NPI: 1720969926
Provider Name (Legal Business Name): JENNIFER RIZZO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 STATE ROAD 75
DIXON NM
87527-9998
US

IV. Provider business mailing address

PO BOX 236
EMBUDO NM
87531-0236
US

V. Phone/Fax

Practice location:
  • Phone: 731-535-4969
  • Fax:
Mailing address:
  • Phone: 731-535-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2026-0107
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: