Provider Demographics
NPI:1205621232
Name:HATLEY, KRISTIN (MT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HATLEY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HALE CIR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-0305
Mailing Address - Country:US
Mailing Address - Phone:505-235-4869
Mailing Address - Fax:505-461-0137
Practice Address - Street 1:4147 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6741
Practice Address - Country:US
Practice Address - Phone:505-553-0555
Practice Address - Fax:505-461-0137
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT9526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist