Provider Demographics
NPI:1164846705
Name:GUIDRY, BRADEN (PT)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 POLLY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4960
Mailing Address - Country:US
Mailing Address - Phone:337-261-9100
Mailing Address - Fax:337-261-9700
Practice Address - Street 1:311 POLLY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4960
Practice Address - Country:US
Practice Address - Phone:337-261-9100
Practice Address - Fax:337-261-9700
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist