Provider Demographics
NPI:1669773289
Name:NAMASTE MASSAGE & THERAPEUTICS, INC.
Entity type:Organization
Organization Name:NAMASTE MASSAGE & THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:REA
Authorized Official - Last Name:LANDRENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT
Authorized Official - Phone:318-730-4517
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-0277
Mailing Address - Country:US
Mailing Address - Phone:318-730-4517
Mailing Address - Fax:866-834-6104
Practice Address - Street 1:713 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2724
Practice Address - Country:US
Practice Address - Phone:318-730-4517
Practice Address - Fax:866-834-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4824-01163WM1400X
LARN115206163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Single Specialty