Provider Demographics
NPI:1235895939
Name:MABREY, TONETTE MARIE (LMT LA 9071)
Entity Type:Individual
Prefix:MS
First Name:TONETTE
Middle Name:MARIE
Last Name:MABREY
Suffix:
Gender:F
Credentials:LMT LA 9071
Other - Prefix:MS
Other - First Name:TONETTE
Other - Middle Name:MARIE
Other - Last Name:MABREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT LA 9071
Mailing Address - Street 1:64533 BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5017
Mailing Address - Country:US
Mailing Address - Phone:941-356-7619
Mailing Address - Fax:
Practice Address - Street 1:64533 BIRCH COURT
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist