Annette Jacks
Individual provider Active NPI Massage Therapist · Placitas, NM
NPI 1508209404 · NPPES record last updated Oct 30, 2013
Key facts
- NPI
- 1508209404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 7545 (NM)
- Practice address
- 3 Homesteads Rd Ste D
Placitas, NM 87043-9229 - Phone
- (970) 903-2213
- NPI assigned
- Apr 10, 2013
- 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 |
|---|---|---|---|
| 7545 | NM | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 7545 | NM | Yes |
Addresses
Primary practice location
3 Homesteads Rd Ste D
Placitas, NM 87043-9229
Mailing address
3 Homesteads Rd Ste D
Placitas, NM 87043-9229
Phone (970) 903-2213
Other providers in Placitas, NM
- Mike Lee Gallegos
- Sally Rae Goble
- Robert Hinman
- Nadine Marie Hober
- Integrity Orthotics and Prosthetics LLC
- Herbert Koffler
- Kristin Kotkowski
- Patrick Andrew Laughlin
- Lauri Lineweaver
- David Lisak
All providers in Placitas, NM · Massage Therapist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2013. 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.