Healthcare Provider Details

I. General information

NPI: 1124430103
Provider Name (Legal Business Name): WANDA KAREN PERRY CR, LMT, CMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12357 HAYNES ST.
CLINTON LA
70722-3717
US

IV. Provider business mailing address

PO BOX 663
GREENSBURG LA
70441-0663
US

V. Phone/Fax

Practice location:
  • Phone: 985-507-7617
  • Fax:
Mailing address:
  • Phone: 985-507-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3985
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: