Provider Demographics
NPI:1750144929
Name:ROBICHAUX, BRANDON KYLE
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:KYLE
Last Name:ROBICHAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3202
Mailing Address - Country:US
Mailing Address - Phone:504-559-7054
Mailing Address - Fax:
Practice Address - Street 1:4 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-3202
Practice Address - Country:US
Practice Address - Phone:504-559-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist