Healthcare Provider Details

I. General information

NPI: 1740103225
Provider Name (Legal Business Name): STEPHANIE ROBERTS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 GAUSE BLVD
SLIDELL LA
70458-2840
US

IV. Provider business mailing address

2405 VIOLET ST
VIOLET LA
70092-3125
US

V. Phone/Fax

Practice location:
  • Phone: 504-473-3234
  • Fax:
Mailing address:
  • Phone: 504-473-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA4523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: