Provider Demographics
NPI:1972537843
Name:BARZENICK, BRENNA M (PT)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:M
Last Name:BARZENICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 C M FAGAN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5938
Mailing Address - Country:US
Mailing Address - Phone:985-542-6664
Mailing Address - Fax:985-542-6428
Practice Address - Street 1:1100 C M FAGAN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5938
Practice Address - Country:US
Practice Address - Phone:985-542-6664
Practice Address - Fax:985-542-6428
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC3657OtherBLUE CROSS
LA5X613CK16Medicare PIN