Provider Demographics
NPI:1356974927
Name:REAUX, BRADLEY JAMES (LAT, ATC, ITAT, CAFS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:REAUX
Suffix:
Gender:M
Credentials:LAT, ATC, ITAT, CAFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5101
Mailing Address - Country:US
Mailing Address - Phone:337-552-5668
Mailing Address - Fax:
Practice Address - Street 1:1307 OLD JEANERETTE RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-5801
Practice Address - Country:US
Practice Address - Phone:337-552-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3066072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer