Healthcare Provider Details

I. General information

NPI: 1578869087
Provider Name (Legal Business Name): SALOME MOSSMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 CEDARDALE DR
LAS CRUCES NM
88005-1265
US

IV. Provider business mailing address

845 CEDARDALE DR
LAS CRUCES NM
88005-1265
US

V. Phone/Fax

Practice location:
  • Phone: 575-621-0644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number5856
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: