Healthcare Provider Details

I. General information

NPI: 1174449383
Provider Name (Legal Business Name): ALTON R ALFORD JR. LMT,LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WESTMARK BLVD
LAFAYETTE LA
70506-7371
US

IV. Provider business mailing address

PO BOX 60936
LAFAYETTE LA
70596-0936
US

V. Phone/Fax

Practice location:
  • Phone: 337-901-1150
  • Fax:
Mailing address:
  • Phone: 337-901-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA10071
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: