Provider Demographics
NPI:1427855733
Name:MELANCON, TODD (LMT LA8793)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:MELANCON
Suffix:
Gender:
Credentials:LMT LA8793
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 GOVERNMENT ST APT 208
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-4088
Mailing Address - Country:US
Mailing Address - Phone:225-328-2328
Mailing Address - Fax:
Practice Address - Street 1:1509 GOVERNMENT ST APT 208
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-4088
Practice Address - Country:US
Practice Address - Phone:225-328-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALA8793OtherLOUISIANA BOARD OF MASSAGE THEARAPY