Healthcare Provider Details

I. General information

NPI: 1578271805
Provider Name (Legal Business Name): YOUAKISHIA HOBBS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W JEFFERSON AVE
BASTROP LA
71220-4543
US

IV. Provider business mailing address

209 W JEFFERSON AVE
BASTROP LA
71220-4543
US

V. Phone/Fax

Practice location:
  • Phone: 318-334-2685
  • Fax:
Mailing address:
  • Phone: 318-334-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA9260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: