Luke Alphonso

Individual provider Active NPI Massage Therapist · Leesville, LA

NPI 1154910024 · NPPES record last updated Jan 14, 2021

Key facts

NPI
1154910024
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
LAMT6960 (LA)
Practice address
1108 Port Arthur Ter
Leesville, LA 71446-4600
Phone
(337) 377-0477
Fax
(337) 239-1062
NPI assigned
Jan 14, 2021
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LAMT6960LAMDMassage Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist
Group: 193400000X SINGLE SPECIALTY GROUP
225700000X LAMT6960 LA Yes

Addresses

Primary practice location

1108 Port Arthur Ter
Leesville, LA 71446-4600

Mailing address

1108 Port Arthur Ter
Leesville, LA 71446-4600
Phone (337) 377-0477

Other providers in Leesville, LA

All providers in Leesville, LA · Massage Therapist in Louisiana

Sources for this page

Verify at the official NPI Registry.