Healthcare Provider Details

I. General information

NPI: 1558395319
Provider Name (Legal Business Name): DUDLEY BAILEY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GENIE ST
CHALMETTE LA
70043-2129
US

IV. Provider business mailing address

401 W GENIE ST
CHALMETTE LA
70043-2129
US

V. Phone/Fax

Practice location:
  • Phone: 504-345-2523
  • Fax: 504-389-1243
Mailing address:
  • Phone: 504-345-2523
  • Fax: 504-389-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA0959-01
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: