Provider Demographics
NPI:1801139456
Name:RIES, TANYA (LMT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:RIES
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 1:933 SAN MATEO BLVD NE
Mailing Address - Street 2:STE 500 BOX 262
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1470
Mailing Address - Country:US
Mailing Address - Phone:706-413-2928
Mailing Address - Fax:
Practice Address - Street 1:933 SAN MATEO BLVD NE
Practice Address - Street 2:STE 500 BOX 262
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1470
Practice Address - Country:US
Practice Address - Phone:706-413-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist