Healthcare Provider Details

I. General information

NPI: 1922363597
Provider Name (Legal Business Name): LEANNE LOUISE CHATTEY CTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RODEO PARK DR E BLDG 3 SANTE FE SOUL HEALTH AND HEALING CENTER
SANTA FE NM
87505-6313
US

IV. Provider business mailing address

1 BRIMHALL WASH
SANTE FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-8885
  • Fax:
Mailing address:
  • Phone: 505-795-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: