Healthcare Provider Details

I. General information

NPI: 1649319088
Provider Name (Legal Business Name): GLENNA C ALLENBERG LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MIEL DE LUNA AVE
TUCUMCARI NM
88401-3810
US

IV. Provider business mailing address

1817 S 6TH ST
TUCUMCARI NM
88401-3655
US

V. Phone/Fax

Practice location:
  • Phone: 505-461-7233
  • Fax:
Mailing address:
  • Phone: 505-403-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0398
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: