Healthcare Provider Details

I. General information

NPI: 1326307034
Provider Name (Legal Business Name): DAN MITCHELL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 E LOHMAN AVE
LAS CRUCES NM
88011-8269
US

IV. Provider business mailing address

2929 SCENIC CIR
LAS CRUCES NM
88011-0815
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-9960
  • Fax: 575-525-9958
Mailing address:
  • Phone: 425-387-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6978
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: