Provider Demographics
NPI:1477662096
Name:ROTHAERMEL, BRETT JUBIN (MD, PT)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:JUBIN
Last Name:ROTHAERMEL
Suffix:
Gender:M
Credentials:MD, PT
Other - Prefix:
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Mailing Address - Street 1:1965 S CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5483
Mailing Address - Country:US
Mailing Address - Phone:504-779-2667
Mailing Address - Fax:504-889-7120
Practice Address - Street 1:3601 HOUMA BLVD STE 203
Practice Address - Street 2:EAST JEFFRSON OCCUPATIONAL MEDICINE CLINIC
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4301
Practice Address - Country:US
Practice Address - Phone:504-779-2667
Practice Address - Fax:504-889-7120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD202040208100000X
LA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508497Medicaid