Healthcare Provider Details

I. General information

NPI: 1740088277
Provider Name (Legal Business Name): MUSCULAR THERAPEUTICS - MONROE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 TOWER DR STE 3
MONROE LA
71201-5779
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 318-660-1111
  • Fax: 318-383-1014
Mailing address:
  • Phone: 504-250-5283
  • Fax: 318-666-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. NICK GWYN
Title or Position: MEMBER
Credential:
Phone: 504-250-5283