Therapeutic by Design Fitness and Wellness, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

04964 Issued in LA

Legal business name

THERAPEUTIC BY DESIGN FITNESS AND WELLNESS, LLC

Practice address

1901 Highway 190 Ste 26
Mandeville, LA 70448-3495

Phone

(985) 778-2282

Fax

(866) 767-8329

NPI assigned

Jun 13, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jennifer Marie Fabre Fairley, P.T., PH.D., CSCSNPI 1700881133

Title

Member Manager

Phone

(985) 778-2282

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Marie Fabre Fairley, P.T. PH.D. CSCS

  • Physical Therapist
  • Mandeville, LA
  • NPI 1700881133
  Medicare reassignment Authorized official
• Kristen Dufour, D.P.T.

  • Physical Therapist
  • Covington, LA
  • NPI 1821498262
  NPD
• Monique M Franklin, OT

  • Occupational Therapist
  • Baton Rouge, LA
  • NPI 1972714715
  NPD (past)
• Don E Gulczynski, LOTR

  • Occupational Therapist
  • Baton Rouge, LA
  • NPI 1003981838
  NPD (past)
• Tracie Lashelle Jackson, P.T., DPT

  • Physical Therapist
  • Baton Rouge, LA
  • NPI 1487948154
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1790780120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 HIGHWAY 190 STE 26",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704483495",
            "telephone_number": "985-778-2282",
            "fax_number": "866-767-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 HIGHWAY 190 STE 26",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704483495",
            "telephone_number": "985-778-2282",
            "fax_number": "866-767-8329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTIC BY DESIGN FITNESS AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A",
        "authorized_official_last_name": "FABRE FAIRLEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "985-778-2282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "P.T., PH.D., CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "04964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1715026",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Contrina Thomas, M.ED.
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• Physical Therapist in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.