Healthcare Provider Details

I. General information

NPI: 1225592579
Provider Name (Legal Business Name): LYFE N MOTION PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3827 SPENCER ST
HARVEY LA
70058-5910
US

IV. Provider business mailing address

3857 IRWIN KUNTZ DR
HARVEY LA
70058-2128
US

V. Phone/Fax

Practice location:
  • Phone: 504-628-6394
  • Fax:
Mailing address:
  • Phone: 504-628-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIAPATRICE BURROWS-ALLEN
Title or Position: OWNER
Credential:
Phone: 504-628-6394