Individual provider · NPI-1

Jacqueline Carol Addis, MSPT

Physical Therapist · Albuquerque, NM

NPI number1922047620
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1922047620
Entity type
Individual (NPI-1)
Name
Jacqueline Carol Addis
Credential
MSPT
Sex
Female
Sole proprietor
No
Enumeration date
Jun 6, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist963NMYes

Practice location

Vamc 1501 San Pedro Dr Ne
Albuquerque, NM 87105

Phone 505-265-1711

Mailing address

Vamc 1501 San Pedro Dr Ne
Albuquerque, NM 87105

Phone 505-265-1711

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