Provider Demographics
NPI:1457687741
Name:KELEHER, SANAM ELIZABETH RADJY
Entity Type:Individual
Prefix:MRS
First Name:SANAM
Middle Name:ELIZABETH RADJY
Last Name:KELEHER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SANAM
Other - Middle Name:
Other - Last Name:RADJY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:305 VASSAR DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2826
Mailing Address - Country:US
Mailing Address - Phone:505-242-1461
Mailing Address - Fax:
Practice Address - Street 1:305 VASSAR DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2826
Practice Address - Country:US
Practice Address - Phone:505-242-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist