Provider Demographics
NPI:1689655417
Name:SIMPSON, BRIAN KEITH (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:SIMPSON
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 1:3300 BEHRMAN PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8215
Mailing Address - Country:US
Mailing Address - Phone:504-374-0015
Mailing Address - Fax:504-374-0016
Practice Address - Street 1:3300 BEHRMAN PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8215
Practice Address - Country:US
Practice Address - Phone:504-374-0015
Practice Address - Fax:504-374-0016
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B338CF61Medicare PIN