Provider Demographics
NPI:1790446870
Name:PERCY, MARK BLAKE (LMT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:BLAKE
Last Name:PERCY
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 1:8741 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1507
Mailing Address - Country:US
Mailing Address - Phone:504-509-8015
Mailing Address - Fax:
Practice Address - Street 1:8741 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1507
Practice Address - Country:US
Practice Address - Phone:504-509-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist