Healthcare Provider Details

I. General information

NPI: 1508493487
Provider Name (Legal Business Name): DYSPHAGIA IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 POEYFARRE ST UNIT 364
NEW ORLEANS LA
70130-3853
US

IV. Provider business mailing address

920 POEYFARRE ST UNIT 364
NEW ORLEANS LA
70130-3853
US

V. Phone/Fax

Practice location:
  • Phone: 321-945-5446
  • Fax:
Mailing address:
  • Phone: 321-945-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: HONG NGUYEN
Title or Position: OWNER
Credential:
Phone: 504-641-4130