Provider Demographics
NPI:1639554348
Name:GREY, DEBRA (NM LMT#8184)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:NM LMT#8184
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LUISA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4091
Mailing Address - Country:US
Mailing Address - Phone:505-490-7895
Mailing Address - Fax:
Practice Address - Street 1:1418 LUISA ST STE 1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4091
Practice Address - Country:US
Practice Address - Phone:505-490-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT #8184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist