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General NPI Number Information
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NPI Number | 1578689006
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Entity Type | Individual
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Provider Name | KRISTINE MARIE ROY
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 EUBANK BLVD NE SUITE 2
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-5386
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Country | US
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Telephone | 505-264-2906
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6248
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City | ALBUQUERQUE
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State | NM
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Zip | 87197-6248
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Country | US
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Telephone | 505-345-3909
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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 | 2875
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6013
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License Number State | AZ
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