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NPI Code Detail

MEDICARE: MRS. JACKIE LINN BRASSEAUX LMT

MEDICARE:  MRS. JACKIE LINN BRASSEAUX  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist4751-2LA

General Provider Information

NPI Number : 1255615290
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACKIE LINN BRASSEAUX LMT
Provider Business Mailing Address
First Line : 1857 WOODDALE BOULEVARD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70706
Country : US
Telephone Number : 225-927-8160
Fax Number : 225-927-7751
Provider Business Practice Location Address
First Line : 1857 WOODDALE BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-1510
Country : US
Telephone Number : 225-927-8160
Fax Number : 225-927-7751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2011
Last Update Date : 10/10/2011

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Directions to “ MRS. JACKIE LINN BRASSEAUX LMT” Practice Location

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