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General NPI Number Information
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NPI Number | 1538573027
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Entity Type | Organization
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Legal Business Name | SOL STATE MASSAGE
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 5353 WYOMING BLVD NE SUITE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87109
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Country | US
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Telephone | 505-350-7203
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Fax |
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Provider Business Mailing Address
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Address Line | 6428 PEPPERDINE ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1216
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Country | US
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Telephone | 505-350-7203
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Fax |
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Authorized Official
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Title or Position | MEDICAL MASSAGE THERAPIST/LMT
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Name | KARRI L HAUSER
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Credential | MMT,
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Telephone | 505-350-7203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 7742
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License Number State | NM
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