Healthcare Provider Details

I. General information

NPI: 1760195283
Provider Name (Legal Business Name): AGAPE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S MORGAN AVE STE A
BROUSSARD LA
70518-4951
US

IV. Provider business mailing address

705 S MORGAN AVE STE A
BROUSSARD LA
70518-4951
US

V. Phone/Fax

Practice location:
  • Phone: 337-258-3683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANNE PELTIER
Title or Position: OWNER
Credential:
Phone: 337-252-7449