Provider Demographics
NPI:1972297547
Name:VIOLET, KRISTA (LMT , BA IN HEALTH)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:VIOLET
Suffix:
Gender:F
Credentials:LMT , BA IN HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 BELLE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4734
Mailing Address - Country:US
Mailing Address - Phone:504-729-7011
Mailing Address - Fax:
Practice Address - Street 1:650 POYDRAS ST # 131
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6101
Practice Address - Country:US
Practice Address - Phone:504-729-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty