Provider Demographics
NPI:1649027293
Name:LOUSIANA MASSAGE BY TREE HOUSE ENRICHMENTS
Entity type:Organization
Organization Name:LOUSIANA MASSAGE BY TREE HOUSE ENRICHMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST/AQUATIC THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANICE
Authorized Official - Middle Name:UNCHELLE
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MT,AT
Authorized Official - Phone:225-428-6614
Mailing Address - Street 1:8733 SIEGEN LN # 401
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1945
Mailing Address - Country:US
Mailing Address - Phone:225-428-6614
Mailing Address - Fax:225-256-0325
Practice Address - Street 1:3103 MONTERREY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-4024
Practice Address - Country:US
Practice Address - Phone:225-428-6614
Practice Address - Fax:225-256-0325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREE HOUSE ENRICHMENTS MASSAGE THERAPY SERVICES,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty