Healthcare Provider Details

I. General information

NPI: 1700739638
Provider Name (Legal Business Name): JONATHAN BITTNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LUISA ST STE R
SANTA FE NM
87505-4073
US

IV. Provider business mailing address

930 LOPEZ ST UNIT C
SANTA FE NM
87501-2421
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-6140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2025-0255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: