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General NPI Number Information
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NPI Number | 1760773659
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Entity Type | Organization
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Legal Business Name | STILLPOINT INTEGRATIVE HEALING, LLC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 624 APPLEWOOD PARK DR SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-7120
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Country | US
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Telephone | 505-264-8267
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Fax |
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Provider Business Mailing Address
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Address Line | 624 APPLEWOOD PARK DR SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-7120
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Country | US
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Telephone | 505-264-8267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA WENGERD
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Credential | LMT, CST
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Telephone | 505-264-8267
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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 | 6662
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License Number State | NM
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