Healthcare Provider Details

I. General information

NPI: 1114386877
Provider Name (Legal Business Name): GARY DOWELL LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

11000 GLADIOLAS PL NW
ALBUQUERQUE NM
87114-6166
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-0321
  • Fax:
Mailing address:
  • Phone: 505-377-0321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7395
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: