Provider Demographics
NPI:1578041026
Name:BROUSSE, RACHAEL ALEXANDRA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ALEXANDRA
Last Name:BROUSSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1665
Mailing Address - Country:US
Mailing Address - Phone:504-360-2584
Mailing Address - Fax:
Practice Address - Street 1:1827 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-1665
Practice Address - Country:US
Practice Address - Phone:504-360-2584
Practice Address - Fax:504-360-2084
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist