Provider Demographics
NPI:1619740958
Name:LASSERE, SYNETHIA H (RN, LMT)
Entity Type:Individual
Prefix:MRS
First Name:SYNETHIA
Middle Name:H
Last Name:LASSERE
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-0277
Mailing Address - Country:US
Mailing Address - Phone:225-398-6868
Mailing Address - Fax:
Practice Address - Street 1:425 W AIRLINE HWY STE L
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3818
Practice Address - Country:US
Practice Address - Phone:225-398-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9849225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist