MEDICARE: STACY FORRESTIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	LA3864	LA

General Provider Information

NPI Number	:	1245073816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY FORRESTIER

Provider Business Mailing Address
First Line	:	925 HARDING ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 HARDING ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2409
Country	:	US
Telephone Number	:	337-501-1721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	06/13/2024

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Directions to “ STACY FORRESTIER ” Practice Location

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