Provider Demographics
NPI:1730310947
Name:AUMILLER, SANDRA LEE (LMT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:AUMILLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:AUMILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:9720 CANDELARIA RD NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1457
Mailing Address - Country:US
Mailing Address - Phone:505-228-0768
Mailing Address - Fax:505-294-7572
Practice Address - Street 1:9720 CANDELARIA RD NE
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1457
Practice Address - Country:US
Practice Address - Phone:505-228-0768
Practice Address - Fax:505-294-7572
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1928171W00000X, 172M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172M00000XOther Service ProvidersMechanotherapist
No174400000XOther Service ProvidersSpecialist