Provider Demographics
NPI:1639891575
Name:MUSCULAR THERAPY LLC
Entity type:Organization
Organization Name:MUSCULAR THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:6521 SPANISH FORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-4321
Mailing Address - Country:US
Mailing Address - Phone:504-571-5355
Mailing Address - Fax:
Practice Address - Street 1:6521 SPANISH FORT BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-4321
Practice Address - Country:US
Practice Address - Phone:504-571-5355
Practice Address - Fax:504-389-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty