Provider Demographics
NPI:1073891347
Name:NEERLY FAMOUS INC
Entity Type:Organization
Organization Name:NEERLY FAMOUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOVELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLINZLER
Authorized Official - Suffix:
Authorized Official - Credentials:LIC-NMB OF B C
Authorized Official - Phone:505-325-8360
Mailing Address - Street 1:2501 E 20TH ST.
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4448
Mailing Address - Country:US
Mailing Address - Phone:505-325-8360
Mailing Address - Fax:505-327-2424
Practice Address - Street 1:2501 E 20TH ST.
Practice Address - Street 2:SUITE #4
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4448
Practice Address - Country:US
Practice Address - Phone:505-325-8360
Practice Address - Fax:505-327-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4960225100000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty