Healthcare Provider Details

I. General information

NPI: 1518429349
Provider Name (Legal Business Name): KERRIE RHODES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRIE PRAVATA LMT

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69282 HIGHWAY 59 STE 4
MANDEVILLE LA
70471-7676
US

IV. Provider business mailing address

69282 HIGHWAY 59 STE 4
MANDEVILLE LA
70471-7676
US

V. Phone/Fax

Practice location:
  • Phone: 985-951-2020
  • Fax: 985-951-2025
Mailing address:
  • Phone: 985-951-2020
  • Fax: 985-951-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number40437315
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: