Provider Demographics
NPI:1538666110
Name:BROUSSARD, RACHEL (CSA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4119
Mailing Address - Country:US
Mailing Address - Phone:337-298-8308
Mailing Address - Fax:
Practice Address - Street 1:19343 SUNSHINE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5160
Practice Address - Country:US
Practice Address - Phone:985-892-5117
Practice Address - Fax:985-898-5932
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty