Provider Demographics
NPI:1730426917
Name:BANTEAUX, HAYLEY BENHAM (LMT)
Entity type:Individual
Prefix:MISS
First Name:HAYLEY
Middle Name:BENHAM
Last Name:BANTEAUX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SYCAMORE ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-5229
Mailing Address - Country:US
Mailing Address - Phone:505-385-4042
Mailing Address - Fax:505-265-9800
Practice Address - Street 1:405 SYCAMORE ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5229
Practice Address - Country:US
Practice Address - Phone:505-385-4042
Practice Address - Fax:505-265-9800
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7426OtherLICENSED MASSAGE THERAPIST