Provider Demographics
NPI:1114193893
Name:MEYER, LINDA L (MTPT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:MEYER
Suffix:
Gender:F
Credentials:MTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 PIERMONT DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3455
Mailing Address - Country:US
Mailing Address - Phone:505-296-5336
Mailing Address - Fax:505-830-3584
Practice Address - Street 1:4103 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-830-3585
Practice Address - Fax:505-830-3584
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1707OtherMASSAGE THERAPY LICENSE #