Provider Demographics
NPI:1780737338
Name:GOSSETT, SALLY DENISE (NTS)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:DENISE
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:NTS
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 37277
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-7277
Mailing Address - Country:US
Mailing Address - Phone:505-610-7784
Mailing Address - Fax:
Practice Address - Street 1:3901 GEORGIA ST NE
Practice Address - Street 2:SUITE A-4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1359
Practice Address - Country:US
Practice Address - Phone:595-610-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist