Provider Demographics
NPI:1003579186
Name:LOWE, KATINA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 TANZANITE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1853
Mailing Address - Country:US
Mailing Address - Phone:505-239-9644
Mailing Address - Fax:
Practice Address - Street 1:705 GRACE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1232
Practice Address - Country:US
Practice Address - Phone:505-239-9644
Practice Address - Fax:505-896-2958
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist