Provider Demographics
NPI:1306395769
Name:STAUFFACHER, CONSTANCE (LMT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:STAUFFACHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:AO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3540 SHILOH RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-2572
Mailing Address - Country:US
Mailing Address - Phone:503-689-5536
Mailing Address - Fax:
Practice Address - Street 1:4263 MONTGOMERY BLVD NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6708
Practice Address - Country:US
Practice Address - Phone:503-689-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8324225700000X
NM23018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist