Provider Demographics
NPI:1609769595
Name:MUSCULAR THERAPY - METAIRIE LLC
Entity type:Organization
Organization Name:MUSCULAR THERAPY - METAIRIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GWYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-571-5355
Mailing Address - Street 1:609 METAIRIE RD # 4014
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4034
Mailing Address - Country:US
Mailing Address - Phone:504-571-5355
Mailing Address - Fax:504-389-4558
Practice Address - Street 1:2329 EDENBORN AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1815
Practice Address - Country:US
Practice Address - Phone:504-571-5355
Practice Address - Fax:504-389-4558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSCULAR THERAPY - METAIRIE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty