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NPI Code Detail

MEDICARE: DUDLEY RAVEN BAILEY LMT

MEDICARE: DUDLEY RAVEN BAILEY LMT
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
1225700000XMassage TherapistLA0959-01LA

General Provider Information

NPI Number : 1558395319
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUDLEY RAVEN BAILEY LMT
Provider Business Mailing Address
First Line : 6521 SPANISH FORT BLVD
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70124-4321
Country : US
Telephone Number : 504-571-5355
Fax Number : 504-389-4558
Provider Business Practice Location Address
First Line : 6521 SPANISH FORT BLVD
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70124-4321
Country : US
Telephone Number : 504-571-5355
Fax Number : 504-389-4558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/09/2024

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Directions to “ DUDLEY RAVEN BAILEY LMT” Practice Location

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