Provider Demographics
NPI:1710981253
Name:MURPHY, MICHAEL B (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:MURPHY
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 1:3939 HOUMA BLVD
Mailing Address - Street 2:#17 DOCTOR'S ROW
Mailing Address - City:METAINE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-885-9121
Mailing Address - Fax:504-885-0322
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:#17 DOCTOR'S ROW
Practice Address - City:METAINE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-885-9121
Practice Address - Fax:504-885-0322
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00392208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124816OtherAETNA
650017829OtherMEDICARE RAILROAD
PT0392OtherWORKMAN'S COMP
6400173OtherUHC
173698100OtherICS
650017829OtherMEDICARE RAILROAD