Healthcare Provider Details

I. General information

NPI: 1730367376
Provider Name (Legal Business Name): VALERIE WALTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 SOUTHERN BLVD. SUITE 102
RIO RANCHO NM
87124-8768
US

IV. Provider business mailing address

2006 SOUTHERN BLVD. SUITE 102
RIO RANCHO NM
87124-8768
US

V. Phone/Fax

Practice location:
  • Phone: 505-917-3912
  • Fax:
Mailing address:
  • Phone: 505-917-3912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10575
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: