=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811787369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CMT THERAPY. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20104 SANIBEL AVE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70817-7041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-505-6031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20104 SANIBEL AVE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70817-7041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-505-6031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL PRACTITIONER
-----------------------------------------------------
Name | MRS. CHELSEA M TRICE
-----------------------------------------------------
Credential | LCSW-BACS
-----------------------------------------------------
Telephone | 225-505-6031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------