MEDICARE: NEERLY FAMOUS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4960	NM
2	225700000X	Massage Therapist	4960	NM

General Provider Information

NPI Number	:	1073891347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEERLY FAMOUS INC

Provider Business Mailing Address
First Line	:	2501 E 20TH ST.
Second Line	:	SUITE #4
City	:	FARMINGTON
State	:	NM
Zip	:	87401-4448
Country	:	US
Telephone Number	:	505-325-8360
Fax Number	:	505-327-2424

Provider Business Practice Location Address
First Line	:	2501 E 20TH ST.
Second Line	:	SUITE #4
City	:	FARMINGTON
State	:	NM
Zip	:	87401-4448
Country	:	US
Telephone Number	:	505-325-8360
Fax Number	:	505-327-2424

Authorized Official
Title or Position	:	PRESIDENT/OWNER/OPERATOR
Name	:	MRS. JOVELLA BLINZLER
Credential	:	LIC-NMB OF B C
Telephone Number	:	505-325-8360

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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Directions to “NEERLY FAMOUS INC ” Practice Location

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