# THERAPEUTIC BY DESIGN FITNESS AND WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790780120
- **Authorized official:** DR. JENNIFER MARIE FABRE FAIRLEY P.T., PH.D., CSCS (MEMBER MANAGER)
- **Authorized official phone:** (985) 778-2282

## Contact information

- **Practice address:** 1901 HIGHWAY 190 STE 26, MANDEVILLE, LA 70448-3495
- **Practice address phone:** (985) 778-2282
- **Practice address fax:** (866) 767-8329
- **Mailing address:** 1901 HIGHWAY 190 STE 26, MANDEVILLE, LA 70448-3495
- **Mailing address phone:** (985) 778-2282
- **Mailing address fax:** (866) 767-8329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 04964 | LA | Yes |

## Other

- **Enumeration date:** 06/13/2005
- **Last updated:** 09/01/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1715026 | — | LA |