Provider Demographics
NPI:1548484116
Name:COUNTS, ROBERT D (RPH, LMT,CHOM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:COUNTS
Suffix:
Gender:M
Credentials:RPH, LMT,CHOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 78 BOX 10732
Mailing Address - Street 2:14 LA MORADA RD
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-0732
Mailing Address - Country:US
Mailing Address - Phone:505-758-4001
Mailing Address - Fax:
Practice Address - Street 1:14 LA MORADA ROAD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-0732
Practice Address - Country:US
Practice Address - Phone:505-758-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2697 MASSAGE172M00000X
175L00000X
NM38671835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered172M00000XOther Service ProvidersMechanotherapist
Not Answered175L00000XOther Service ProvidersHomeopath
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00R76VOtherBCBS