Provider Demographics
NPI:1023129632
Name:HUSSEY, SANDRA LEE (LMT CNMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:LMT CNMT
Other - Prefix:
Other - First Name:S L LEANDRA
Other - Middle Name:
Other - Last Name:HUSSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT CNMT
Mailing Address - Street 1:1044 SANDIA VISTA RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5160
Mailing Address - Country:US
Mailing Address - Phone:505-304-2279
Mailing Address - Fax:505-891-8637
Practice Address - Street 1:3939 SAN PEDRO DR NE
Practice Address - Street 2:SUITE C5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8900
Practice Address - Country:US
Practice Address - Phone:505-304-2279
Practice Address - Fax:505-891-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92071OtherPRESBYTERIAN HEALTH PLAN
NMRD098OtherBCBS BLUE CROSS BLUE SHIE