Healthcare Provider Details

I. General information

NPI: 1639089584
Provider Name (Legal Business Name): JULIE ANA WORTMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 W ANIMAS ST
FARMINGTON NM
87401-5617
US

IV. Provider business mailing address

PO BOX 1184
BLOOMFIELD NM
87413-1184
US

V. Phone/Fax

Practice location:
  • Phone: 505-330-7405
  • Fax:
Mailing address:
  • Phone: 505-330-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2026-0047
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: