Provider Demographics
NPI:1669645552
Name:TATE, VIOLET D (LMT, LPN)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:D
Last Name:TATE
Suffix:
Gender:F
Credentials:LMT, LPN
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 1612
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-1612
Mailing Address - Country:US
Mailing Address - Phone:985-796-3364
Mailing Address - Fax:985-796-9116
Practice Address - Street 1:83370 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437
Practice Address - Country:US
Practice Address - Phone:985-796-3364
Practice Address - Fax:985-796-9116
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1498-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669531372Medicaid