Healthcare Provider Details

I. General information

NPI: 1134215965
Provider Name (Legal Business Name): DE AYN JACKSON CURTIS LMT LICENSED MASSAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 MESA BAJA
ROWE NM
87562
US

IV. Provider business mailing address

PO BOX 195
ROWE NM
87562
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-3601
  • Fax:
Mailing address:
  • Phone: 505-757-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number825
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: