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General NPI Number Information
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NPI Number | 1265254783
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE DONOVAN LMT, AAMP, CLT
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1005 21ST ST SE # 5
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City | RIO RANCHO
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State | NM
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Zip | 87124-4030
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Country | US
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Telephone | 505-510-2270
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Fax |
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Provider Business Mailing Address
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Address Line | 444 PEACEFUL MEADOWS DR NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-4104
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Country | US
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Telephone | 505-510-2270
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MT9232
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License Number State | NM
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