Provider Demographics
NPI:1710571328
Name:CASTANEL, KIM (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CASTANEL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7326 TRAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1638
Mailing Address - Country:US
Mailing Address - Phone:504-708-8858
Mailing Address - Fax:
Practice Address - Street 1:3200 LAKE VILLA DR STE 203
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5549
Practice Address - Country:US
Practice Address - Phone:504-708-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist