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General NPI Number Information
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NPI Number | 1093371973
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Entity Type | Individual
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Provider Name | LEAH LYN FITZGERALD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 3654 GOVERNMENT ST STE 5
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City | ALEXANDRIA
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State | LA
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Zip | 71302-3324
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Country | US
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Telephone | 318-613-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 3654 GOVERNMENT ST STE 5
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City | ALEXANDRIA
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State | LA
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Zip | 71302-3324
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Country | US
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Telephone | 318-613-5190
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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 | LA8117
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | RN056512
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License Number State | LA
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