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General NPI Number Information
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NPI Number | 1841807906
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Entity Type | Organization
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Legal Business Name | 12 HOUR MASSAGE 2 LLC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 3113 RYAN ST STE 6
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8587
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Country | US
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Telephone | 337-802-9631
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 RYAN ST STE 6
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8587
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Country | US
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Telephone | 337-802-9631
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Fax |
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Authorized Official
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Title or Position | CO-OWNER & LMT
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Name | MRS. HOLLI COCO GRAVES
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Credential | LMT
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Telephone | 337-302-1675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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