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NPI 1851633135

NPI 1851633135 : TRACEY HUGHES LMT, NTS : EDGEWOOD, NM

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General NPI Number Information
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    NPI Number           |    1851633135
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    Entity Type          |    Individual 
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    Provider Name        |    TRACEY HUGHES LMT, NTS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    03/25/2013
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    Last Update Date     |    03/25/2013
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Provider Practice Location Address
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    Address Line         |    1 LINNIE CT 
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    City                 |    EDGEWOOD
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    State                |    NM
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    Zip                  |    87015-9125
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    Country              |    US
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    Telephone            |    505-286-7838
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    Fax                  |    505-286-8025
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Provider Business Mailing Address
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    Address Line         |    PO BOX 896 
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    City                 |    EDGEWOOD
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    State                |    NM
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    Zip                  |    87015-0896
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    Country              |    US
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    Telephone            |    505-286-7838
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    Fax                  |    505-286-8025
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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       |    5167
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    License Number State |    NM
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