Provider Demographics
NPI:1023622263
Name:CRAVIN, LAKEISHA (LMT)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:CRAVIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:AMA
Mailing Address - State:LA
Mailing Address - Zip Code:70031-0107
Mailing Address - Country:US
Mailing Address - Phone:504-571-9990
Mailing Address - Fax:
Practice Address - Street 1:13755 RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4377
Practice Address - Country:US
Practice Address - Phone:504-571-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8227225700000X
LALA-8227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist