Provider Demographics
NPI:1376242495
Name:SENASACK, AMBER (MT22006)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SENASACK
Suffix:
Gender:F
Credentials:MT22006
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 21ST ST SE STE 9
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4030
Mailing Address - Country:US
Mailing Address - Phone:505-239-9664
Mailing Address - Fax:505-896-2958
Practice Address - Street 1:1005 21ST ST SE STE 9
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4030
Practice Address - Country:US
Practice Address - Phone:505-239-9664
Practice Address - Fax:505-896-2958
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT22006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist