Provider Demographics
NPI:1881750412
Name:SANTORIELLO, KAREN J (LMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:SANTORIELLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:790 STATE HIGHWAY 333
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7306
Mailing Address - Country:US
Mailing Address - Phone:505-307-5250
Mailing Address - Fax:505-286-7782
Practice Address - Street 1:10200 CORRALES RD NW STE D1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-9208
Practice Address - Country:US
Practice Address - Phone:505-307-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4795225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist