Provider Demographics
NPI:1679657084
Name:STROMMEN-MARTIN, LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:STROMMEN-MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LOUISE
Other - Last Name:STROMMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:131 SKYLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-8118
Mailing Address - Country:US
Mailing Address - Phone:505-888-4469
Mailing Address - Fax:
Practice Address - Street 1:3530 PAN AMERICAN FWY NE STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4793
Practice Address - Country:US
Practice Address - Phone:505-888-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist