Letitia M. Henley
Individual provider Active NPI Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician · Vadito, NM
NPI 1245500347 · NPPES record last updated Jan 5, 2012
Key facts
- NPI
- 1245500347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician 2081N0008X
- License
- #5422 (NM)
- Practice address
- #22 Cielo Vista Rd.
Individual Client Homes;
Vadito, NM 87579 - Phone
- (575) 587-1756
- NPI assigned
- Jan 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #5422 | NM | MD | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician | 2081N0008X | #5422 | NM | Yes |
Addresses
Primary practice location
#22 Cielo Vista Rd.
Individual Client Homes;
Vadito, NM 87579
Mailing address
#22 Cielo Vista Rd
Vadito, NM 87579
Phone (575) 587-1756
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.