Provider Demographics
NPI:1790441061
Name:BREAUX BRIDGE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:BREAUX BRIDGE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:BREAUX BRIDGE PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:337-414-6079
Mailing Address - Street 1:1220 N BERARD ST STE B
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4849
Mailing Address - Country:US
Mailing Address - Phone:337-414-6079
Mailing Address - Fax:337-414-6140
Practice Address - Street 1:1220 N BERARD ST STE B
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4849
Practice Address - Country:US
Practice Address - Phone:337-414-6079
Practice Address - Fax:337-414-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty