Healthcare Provider Details

I. General information

NPI: 1548967201
Provider Name (Legal Business Name): ELIZABETH A BARBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHWAY 180 E STE C
SILVER CITY NM
88061-7716
US

IV. Provider business mailing address

705 W MARKET ST
SILVER CITY NM
88061-4545
US

V. Phone/Fax

Practice location:
  • Phone: 503-593-0742
  • Fax:
Mailing address:
  • Phone: 503-593-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT9536
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: