Healthcare Provider Details

I. General information

NPI: 1912418518
Provider Name (Legal Business Name): MICHELLE MARIE LE BLANC LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 CLEARVIEW PKWY
METAIRIE LA
70001-2404
US

IV. Provider business mailing address

4612 ALEXANDER DR
METAIRIE LA
70003-2810
US

V. Phone/Fax

Practice location:
  • Phone: 504-456-9296
  • Fax: 504-456-9799
Mailing address:
  • Phone: 504-495-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2024
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA2024
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: