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General NPI Number Information
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NPI Number | 1366159303
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Entity Type | Individual
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Provider Name | JASMINE RAE STROMBERG DPT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 6745 ACADEMY RD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3373
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Country | US
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Telephone | 505-933-7865
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Fax |
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Provider Business Mailing Address
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Address Line | 409 GIRARD BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2233
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4697
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License Number State | NM
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