Provider Demographics
NPI:1326743303
Name:POWELL, DEVIN K (LMT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:K
Last Name:POWELL
Suffix:
Gender:
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:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1589
Mailing Address - Country:US
Mailing Address - Phone:575-776-1117
Mailing Address - Fax:575-776-1119
Practice Address - Street 1:98 STATE HIGHWAY 150
Practice Address - Street 2:SUITE 7
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-1589
Practice Address - Country:US
Practice Address - Phone:575-776-1117
Practice Address - Fax:575-776-1119
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8773174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist