Individual
MARK GREGORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1603 BOONE ST STE C, LEESVILLE, LA 71446-5780
(337) 718-6517
Mailing address
103 MAYO ST, LEESVILLE, LA 71446-3058
(337) 718-6517
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA9846
LA
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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