Provider Demographics
NPI:1669890083
Name:FELKER, DESIREE NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:FELKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ARMADILLO LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5869
Mailing Address - Country:US
Mailing Address - Phone:575-420-5847
Mailing Address - Fax:
Practice Address - Street 1:3961 E LOHMAN AVE
Practice Address - Street 2:SUITE 34
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8269
Practice Address - Country:US
Practice Address - Phone:575-585-9960
Practice Address - Fax:575-525-9958
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7343172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist