NPIMap

Organization Active NPI

Southwest Myotherapy

  • Massage Therapist
  • Albuquerque, NM
National Provider Identifier
1679725667
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
4024 Issued in NM
Legal business name
SOUTHWEST MYOTHERAPY
Practice address
4103 Montgomery Blvd NE
Albuquerque, NM 87109-1102
Phone
(505) 830-3585
Fax
(505) 830-3584
NPI assigned
Oct 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Karen P. Carbonneau
Title
Office Manager
Phone
(505) 830-3585

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X 1707 NM
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X 4024 NM Primary

Addresses

Primary practice location

4103 Montgomery Blvd NE
Albuquerque, NM 87109-1102

Mailing address

4103 Montgomery Blvd NE
Albuquerque, NM 87109-1102
Phone (505) 830-3585

Other identifiers 2

IdentifierTypeStateIssuer
1114193893OtherNMNPI
1972650224OtherNMNPI

National Provider Directory

National Provider Directory

Locations

4103 Montgomery Blvd NE
Albuquerque, NM 87109
Phone (505) 830-3585

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1679725667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091102",
            "telephone_number": "505-830-3585",
            "fax_number": "505-830-3584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091102",
            "telephone_number": "505-830-3585",
            "fax_number": "505-830-3584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MYOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "CARBONNEAU",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-830-3585",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NM",
            "license": "1707",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NM",
            "license": "4024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1114193893",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972650224",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.