Provider Demographics
NPI:1972051993
Name:BRADEN GUIDRY, PT, LLC
Entity Type:Organization
Organization Name:BRADEN GUIDRY, PT, LLC
Other - Org Name:CHURCH POINT THERAPY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT/DPT
Authorized Official - Phone:337-684-0070
Mailing Address - Street 1:107 PONTCHARTRAIN DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5271
Mailing Address - Country:US
Mailing Address - Phone:337-684-0070
Mailing Address - Fax:337-684-0146
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-3115
Practice Address - Country:US
Practice Address - Phone:337-684-0070
Practice Address - Fax:337-684-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08576261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy