Healthcare Provider Details

I. General information

NPI: 1265254783
Provider Name (Legal Business Name): CHRISTINE MARIE DONOVAN LMT, AAMP, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE # 5
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

444 PEACEFUL MEADOWS DR NE
RIO RANCHO NM
87144-4104
US

V. Phone/Fax

Practice location:
  • Phone: 505-510-2270
  • Fax:
Mailing address:
  • Phone: 505-510-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT9232
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: