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General NPI Number Information
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NPI Number | 1831367093
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Entity Type | Individual
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Provider Name | MR. DEMOSTHENES STEPHEN METARELIS
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Gender | Male
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 8006 MENAUL NE MASSAGE THERAPY WITH LOVE AT ALIVE & WELL CENTER
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4608
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Country | US
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Telephone | 505-271-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 829 CLAUDINE NE MASSAGE THERAPY WITH LOVE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-1224
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Country | US
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Telephone | 505-296-4396
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2950
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License Number State | NM
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