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General NPI Number Information
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NPI Number | 1578242558
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Entity Type | Organization
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Legal Business Name | ALEISHA LUNDSTROM, LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 98 RODEO GROUND ROAD GRANTS, NM 87020
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City | GRANTS
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State | NM
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Zip | 87020
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Country | US
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Telephone | 505-270-9733
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | GRANTS
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State | NM
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Zip | 87020-0027
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Country | US
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Telephone | 505-270-9733
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | ALEISHA LUNDSTROM
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Credential | MPT
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Telephone | 505-270-9733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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