Healthcare Provider Details

I. General information

NPI: 1053634568
Provider Name (Legal Business Name): LU ANN ROBINSON PTA, LMT, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2538 CAMINO ENTRADA
SANTA FE NM
87507-4919
US

IV. Provider business mailing address

2538 CAMINO ENTRADA
SANTA FE NM
87507-4919
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-1239
  • Fax: 505-424-1239
Mailing address:
  • Phone: 505-424-1239
  • Fax: 505-464-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0129621
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7960
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1367
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: