Healthcare Provider Details

I. General information

NPI: 1609792001
Provider Name (Legal Business Name): STEVIE RAE GIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2026-0099
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: