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General NPI Number Information
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NPI Number | 1255485652
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Entity Type | Individual
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Provider Name | GLENDA CLEMMER BLY LMT, RMT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2905 N PRINCE ST SUITE C
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City | CLOVIS
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State | NM
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Zip | 88101-3843
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Country | US
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Telephone | 505-763-0551
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 784
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City | FARWELL
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State | TX
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Zip | 79325-0784
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Country | US
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Telephone | 806-481-8181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3498
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT022683
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License Number State | TX
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