Healthcare Provider Details

I. General information

NPI: 1245484542
Provider Name (Legal Business Name): CARTER BECKETT L.M.T, C.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 PLACITA SANTA FE
SANTA FE NM
87505-4543
US

IV. Provider business mailing address

760 PLACITA SANTA FE
SANTA FE NM
87505-4543
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-5457
  • Fax: 505-983-5459
Mailing address:
  • Phone: 505-983-5457
  • Fax: 505-983-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0128
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: