Provider Demographics
NPI:1952450504
Name:TALLEY, KARINE L (MSPT, CEAS)
Entity Type:Individual
Prefix:
First Name:KARINE
Middle Name:L
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MSPT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 CAMINO ENTRADA
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4919
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:888-746-4761
Practice Address - Street 1:2538 CAMINO ENTRADA
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4919
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:888-746-4761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist