Healthcare Provider Details

I. General information

NPI: 1760773659
Provider Name (Legal Business Name): STILLPOINT INTEGRATIVE HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 APPLEWOOD PARK DR SE
RIO RANCHO NM
87124-7120
US

IV. Provider business mailing address

624 APPLEWOOD PARK DR SE
RIO RANCHO NM
87124-7120
US

V. Phone/Fax

Practice location:
  • Phone: 505-264-8267
  • Fax:
Mailing address:
  • Phone: 505-264-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6662
License Number StateNM

VIII. Authorized Official

Name: LISA WENGERD
Title or Position: OWNER
Credential: LMT, CST
Phone: 505-264-8267