Provider Demographics
NPI:1144578709
Name:SPECTRUM MASSAGE
Entity Type:Organization
Organization Name:SPECTRUM MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:337-344-2463
Mailing Address - Street 1:101 BERWICK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-344-2463
Mailing Address - Fax:337-993-8466
Practice Address - Street 1:101 BERWICK CIRCLE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-344-2463
Practice Address - Fax:337-993-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA2355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548521909OtherNPPES