Provider Demographics
NPI:1164649109
Name:GENET, CAROLYN E (LMT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:E
Last Name:GENET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ESPINOZA RD
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557
Mailing Address - Country:US
Mailing Address - Phone:505-758-0365
Mailing Address - Fax:
Practice Address - Street 1:224 CRUZ ALTA RD
Practice Address - Street 2:SUITE G
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5947
Practice Address - Country:US
Practice Address - Phone:505-751-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2513225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist