Healthcare Provider Details

I. General information

NPI: 1336604792
Provider Name (Legal Business Name): CHRISTOPHER EHRMAN MAT, ATC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRISTOPHER EHRMAN MAT, ATC, LMT

II. Dates (important events)

Enumeration Date: 02/09/2019
Last Update Date: 02/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 31ST ST STE D
MONROE LA
71201-3942
US

IV. Provider business mailing address

808 N 31ST ST STE D
MONROE LA
71201-3942
US

V. Phone/Fax

Practice location:
  • Phone: 318-548-8594
  • Fax:
Mailing address:
  • Phone: 318-548-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA7504
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: