Provider Demographics
NPI:1871934034
Name:CHRISTENSEN, ELIZABETH C (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:CHRISTENSEN
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 1:1917 OLD US 66
Mailing Address - Street 2:SUITE G
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-6762
Mailing Address - Country:US
Mailing Address - Phone:505-980-3599
Mailing Address - Fax:
Practice Address - Street 1:1917 OLD US 66
Practice Address - Street 2:SUITE G
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6762
Practice Address - Country:US
Practice Address - Phone:505-980-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist