Provider Demographics
NPI:1386180891
Name:GAUTREAU, JOSHUA RYAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:RYAN
Last Name:GAUTREAU
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 JERLYN DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5105
Mailing Address - Country:US
Mailing Address - Phone:225-337-6623
Mailing Address - Fax:
Practice Address - Street 1:8448 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1938
Practice Address - Country:US
Practice Address - Phone:225-757-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7039173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist