Provider Demographics
NPI:1881863819
Name:DE MARSH, PATRICIA LEE (LMT CMT NMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:DE MARSH
Suffix:
Gender:F
Credentials:LMT CMT NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 350176
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176
Mailing Address - Country:US
Mailing Address - Phone:505-453-4956
Mailing Address - Fax:
Practice Address - Street 1:901 3RD ST NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-453-4956
Practice Address - Fax:505-242-4300
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5169225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist