Healthcare Provider Details

I. General information

NPI: 1164392668
Provider Name (Legal Business Name): ALEX MIZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 MINERAL RD
BROUSSARD LA
70518-7105
US

IV. Provider business mailing address

127 SANTA INES ST
NEW IBERIA LA
70563-1331
US

V. Phone/Fax

Practice location:
  • Phone: 337-326-2425
  • Fax:
Mailing address:
  • Phone: 337-326-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA8408
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: