Provider Demographics
NPI:1003219114
Name:DANIEL HEALEY DBA
Entity Type:Organization
Organization Name:DANIEL HEALEY DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-919-9542
Mailing Address - Street 1:8 OLD RD
Mailing Address - Street 2:
Mailing Address - City:LAMY
Mailing Address - State:NM
Mailing Address - Zip Code:87540-9628
Mailing Address - Country:US
Mailing Address - Phone:505-919-9542
Mailing Address - Fax:
Practice Address - Street 1:8 OLD RD
Practice Address - Street 2:
Practice Address - City:LAMY
Practice Address - State:NM
Practice Address - Zip Code:87540-9628
Practice Address - Country:US
Practice Address - Phone:505-919-9542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty