Provider Demographics
NPI:1841676608
Name:MCKEE, DWAYNE T (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:T
Last Name:MCKEE
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 NIAGARA DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4911
Mailing Address - Country:US
Mailing Address - Phone:504-338-4253
Mailing Address - Fax:
Practice Address - Street 1:5508 NIAGARA DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4911
Practice Address - Country:US
Practice Address - Phone:504-338-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4090225700000X
LALA4090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4090OtherLMT