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General NPI Number Information
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NPI Number | 1689070484
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Entity Type | Individual
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Provider Name | TERRY MARIE ENRIQUES MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 433 METAIRIE RD
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City | METAIRIE
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State | LA
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Zip | 70005-4333
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Country | US
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Telephone | 504-835-7554
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Fax |
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Provider Business Mailing Address
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Address Line | 560 TERRACE ST
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City | JEFFERSON
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State | LA
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Zip | 70121-1516
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Country | US
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Telephone | 504-435-5309
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 7860
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License Number State | LA
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