Provider Demographics
NPI:1821431529
Name:SHORTY, BARBARA J (LMT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:SHORTY
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 1:917 US HIGHWAY 491
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5340
Mailing Address - Country:US
Mailing Address - Phone:505-870-0523
Mailing Address - Fax:
Practice Address - Street 1:917 US HIGHWAY 491
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5340
Practice Address - Country:US
Practice Address - Phone:505-870-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist