Provider Demographics
NPI:1518137207
Name:BLASINGAME, MARY-ELIZABETH (LMBT)
Entity Type:Individual
Prefix:
First Name:MARY-ELIZABETH
Middle Name:
Last Name:BLASINGAME
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:BLASINGAME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1101 CARDENAS DR NE
Mailing Address - Street 2:SUITE# 105
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6650
Mailing Address - Country:US
Mailing Address - Phone:505-205-3618
Mailing Address - Fax:
Practice Address - Street 1:1101 CARDENAS DR NE
Practice Address - Street 2:SUITE# 105
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6650
Practice Address - Country:US
Practice Address - Phone:505-205-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7033225700000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist