Provider Demographics
NPI:1841403557
Name:BARE, ELIZABETH J (LMT,)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:J
Last Name:BARE
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 1:2817 INDIAN FARM LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2639
Mailing Address - Country:US
Mailing Address - Phone:505-254-7884
Mailing Address - Fax:
Practice Address - Street 1:2817 INDIAN FARM LN NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2639
Practice Address - Country:US
Practice Address - Phone:505-254-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2753225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist