Alicia David

Individual provider Active NPI Massage Therapist · Brusly, LA

NPI 1740630441 · NPPES record last updated Jun 14, 2016

Key facts

NPI
1740630441
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
LA8219 (LA)
Practice address
822 E Main St
Brusly, LA 70719-2215
Phone
(225) 931-0082
NPI assigned
Jun 14, 2016
Sex
Female
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
LA8219LAMDMassage Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X LA8219 LA Yes

Addresses

Primary practice location

822 E Main St
Brusly, LA 70719-2215

Mailing address

822 East Main St
Brusly, LA 70719
Phone (318) 359-1766

Other providers in Brusly, LA

All providers in Brusly, LA · Massage Therapist in Louisiana

Sources for this page

Verify at the official NPI Registry.