Provider Demographics
NPI:1740409705
Name:KHALSA, KARTAR KAUR (LMT)
Entity Type:Individual
Prefix:
First Name:KARTAR
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CAMINO RIO VISTA
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532
Mailing Address - Country:US
Mailing Address - Phone:505-747-3134
Mailing Address - Fax:505-753-7676
Practice Address - Street 1:521 CAMINO RIO VISTA
Practice Address - Street 2:NORTHERN NEW MEXICO HEALTH CARE 82ACR122
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-753-7576
Practice Address - Fax:505-753-7676
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM278MASSAGETHERAPY225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist