Provider Demographics
NPI:1891046603
Name:FAUGHT, BRITTANY BATES (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:BATES
Last Name:FAUGHT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:ANN
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2018 JAY ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-6648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1702 HIGHWAY 11 N STE B
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2016
Practice Address - Country:US
Practice Address - Phone:601-749-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08375225100000X
MSPT5176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist