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General NPI Number Information
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NPI Number | 1578923447
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Entity Type | Organization
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Legal Business Name | PAMELA LASTER, NTS, LMT, ADS
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 1738 W KENTUCKY AVE
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City | RUSTON
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State | LA
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Zip | 71270-9581
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Country | US
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Telephone | 318-243-2231
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Fax |
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Provider Business Mailing Address
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Address Line | 1738 W KENTUCKY AVE
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City | RUSTON
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State | LA
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Zip | 71270-9581
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Country | US
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Telephone | 318-243-2231
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. PAMELA MICHELE LASTER
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Credential | LMT, ADS
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Telephone | 318-243-2231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000024
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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 | 0309
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License Number State | LA
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