1356273379 NPI number — SOUTHERN SELECT MASSAGE THERAPY LLC

Table of content: (NPI 1356273379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356273379 NPI number — SOUTHERN SELECT MASSAGE THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN SELECT MASSAGE THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356273379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12518 WYNDY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-4759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-448-4499
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1433 OLD HAMOND HWY , 302B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-272-1401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2026

Additional Information

Authorized Official

Authorized Official Last Name:
IVERSTINE
Authorized Official First Name:
TREY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-448-4499

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com