Provider Demographics
NPI:1225718000
Name:TRICHE, BRENNAN KADE
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:KADE
Last Name:TRICHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19262 MERLOT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7671
Mailing Address - Country:US
Mailing Address - Phone:225-936-5669
Mailing Address - Fax:
Practice Address - Street 1:10100 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5267
Practice Address - Country:US
Practice Address - Phone:832-795-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist