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General NPI Number Information
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NPI Number | 1073427332
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Entity Type | Organization
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Legal Business Name | 369 THE TEMPLE LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 1807 JEFFERSON STREET
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City | LAFAYETTE
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State | LA
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Zip | 70501
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Country | US
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Telephone | 337-255-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 JEFFERSON STREET
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City | LAFAYETTE
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State | LA
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Zip | 70501
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Country | US
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Telephone | 337-255-5859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE BLANCHARD
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Credential | LMT
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Telephone | 985-413-0297
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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 |
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License Number State | NULL
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