Healthcare Provider Details

I. General information

NPI: 1235065830
Provider Name (Legal Business Name): SUMMIT WELLNESS OF LA-MS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 PASS RD STE 6
BILOXI MS
39531-4044
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 228-203-2088
  • Fax: 228-277-8070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICK GYWN
Title or Position: COO
Credential:
Phone: 504-571-5355