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General NPI Number Information
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NPI Number | 1568743433
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Entity Type | Individual
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Provider Name | ANDY TRUJILLO LMT, NCTMB
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Gender | Male
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 2903 W 24TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-4925
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Country | US
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Telephone | 308-234-9613
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Fax | 308-234-9614
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Provider Business Mailing Address
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Address Line | 22 W 56TH ST STE 107
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City | KEARNEY
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State | NE
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Zip | 68847-0508
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Country | US
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Telephone | 308-234-9613
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Fax | 308-234-9614
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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 | 1982
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License Number State | NE
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