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NPI Code Detail

MEDICARE: MRS. PENNY MCLAUGHLIN PENDARVIS LMT

MEDICARE: MRS. PENNY MCLAUGHLIN PENDARVIS 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 Therapist4797LA

General Provider Information

NPI Number : 1710260674
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PENNY MCLAUGHLIN PENDARVIS LMT
Provider Business Mailing Address
First Line : 1857 WOODDALE BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-1510
Country : US
Telephone Number : 225-667-0366
Fax Number :
Provider Business Practice Location Address
First Line : 1857 WOODDALE BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-1510
Country : US
Telephone Number : 225-667-0366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2011
Last Update Date : 09/27/2011

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Directions to “ MRS. PENNY MCLAUGHLIN PENDARVIS LMT” Practice Location

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