Healthcare Provider Details

I. General information

NPI: 1851633135
Provider Name (Legal Business Name): TRACEY HUGHES LMT, NTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINNIE CT
EDGEWOOD NM
87015-9125
US

IV. Provider business mailing address

PO BOX 896
EDGEWOOD NM
87015-0896
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-7838
  • Fax: 505-286-8025
Mailing address:
  • Phone: 505-286-7838
  • Fax: 505-286-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5167
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: