Provider Demographics
NPI:1568834851
Name:JASTRAM, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:JASTRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 ARABIAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2247
Mailing Address - Country:US
Mailing Address - Phone:505-363-9232
Mailing Address - Fax:
Practice Address - Street 1:9798 COORS BLVD NW
Practice Address - Street 2:BLDG. C, SUITE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6131
Practice Address - Country:US
Practice Address - Phone:505-363-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist