Provider Demographics
NPI:1700984895
Name:BUNCH, RICHARD W (PHD, PT)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:BUNCH
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 CORPORATE DR.
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2461
Mailing Address - Country:US
Mailing Address - Phone:985-872-5911
Mailing Address - Fax:985-872-6155
Practice Address - Street 1:478 CORPORATE DR.
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2461
Practice Address - Country:US
Practice Address - Phone:985-872-5911
Practice Address - Fax:985-872-6155
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT0290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X876Medicare ID - Type UnspecifiedPROVIDER NUMBER