Healthcare Provider Details

I. General information

NPI: 1457286817
Provider Name (Legal Business Name): MAFIE FREE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 PITTMAN ST
DERIDDER LA
70634-3412
US

IV. Provider business mailing address

732 LEE NICHOLS RD
DERIDDER LA
70634-5164
US

V. Phone/Fax

Practice location:
  • Phone: 337-202-9445
  • Fax:
Mailing address:
  • Phone: 337-202-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8746
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: