=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235901786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUIYING GAO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2023
-----------------------------------------------------
Last Update Date | 12/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8937 JEFFERSON HWY STE B
-----------------------------------------------------
City | RIVER RIDGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-3524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-470-2467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2108 METAIRIE CT
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70001-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-577-6868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | LA9147
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------