Provider Demographics
NPI:1811007362
Name:RACHAL, BRETT G
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:G
Last Name:RACHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 TILFORD CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 ARMAND ST
Practice Address - Street 2:SUITE F
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3754
Practice Address - Country:US
Practice Address - Phone:318-340-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist