=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255131652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUX MED SPA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2025
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 KALISTE SALOOM RD STE H
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-235-0575
-----------------------------------------------------
Fax | 337-235-0575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 KALISTE SALOOM RD STE H
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-235-0575
-----------------------------------------------------
Fax | 337-504-2289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | MS. STEPHANIE MICHELLE HANKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-724-1618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------