Provider Demographics
NPI:1740088277
Name:MUSCULAR THERAPEUTICS - MONROE LLC
Entity type:Organization
Organization Name:MUSCULAR THERAPEUTICS - MONROE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GWYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-250-5283
Mailing Address - Street 1:2329 EDENBORN AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1815
Mailing Address - Country:US
Mailing Address - Phone:504-250-5283
Mailing Address - Fax:318-666-2522
Practice Address - Street 1:1401 N 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4339
Practice Address - Country:US
Practice Address - Phone:318-666-1111
Practice Address - Fax:318-666-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty