| NPI | 1982102620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA BROUSSARD Credentialing Specialist 337-704-5611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2018-01-29 |