Healthcare Provider Details

I. General information

NPI: 1922494855
Provider Name (Legal Business Name): LAURA LEE'S MASSAGE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 FOREMAN DR
LAFAYETTE LA
70506-6208
US

IV. Provider business mailing address

116 FOREMAN DR
LAFAYETTE LA
70506-6208
US

V. Phone/Fax

Practice location:
  • Phone: 318-359-2045
  • Fax: 337-981-0211
Mailing address:
  • Phone: 318-359-2045
  • Fax: 337-981-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2751
License Number StateLA

VIII. Authorized Official

Name: MS. LAURA LEE LACOMBE
Title or Position: OWNER/ MASSAGE THERAPIST
Credential: LMT
Phone: 318-359-2045