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General NPI Number Information
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NPI Number | 1023622263
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Entity Type | Individual
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Provider Name | LAKEISHA CRAVIN LMT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 13755 RIVER RD STE C
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City | LULING
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State | LA
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Zip | 70070-4377
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Country | US
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Telephone | 504-571-9990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 107
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City | AMA
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State | LA
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Zip | 70031-0107
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Country | US
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Telephone | 504-571-9990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | LA8227
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | LA-8227
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License Number State | LA
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