MEDICARE: MS. MOLLY J. HILDRETH NTS, LMT

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	225700000X	Massage Therapist	2528	NM

General Provider Information

NPI Number	:	1588870711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLY J. HILDRETH NTS, LMT

Provider Business Mailing Address
First Line	:	11004 CORDOVA AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1706
Country	:	US
Telephone Number	:	505-235-4550
Fax Number	:

Provider Business Practice Location Address
First Line	:	8005 PENNSYLVANIA CIR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7810
Country	:	US
Telephone Number	:	505-248-0698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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