Healthcare Provider Details

I. General information

NPI: 1063339273
Provider Name (Legal Business Name): SARAH GRACE ORY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH BROOKS LMT

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CHRISTIAN LN
SLIDELL LA
70458-1350
US

IV. Provider business mailing address

103 CHARLES DR
SLIDELL LA
70460-8462
US

V. Phone/Fax

Practice location:
  • Phone: 985-257-4090
  • Fax:
Mailing address:
  • Phone: 985-707-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA10239
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: