Provider Demographics
NPI:1811049356
Name:BRIGNAC PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BRIGNAC PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGNAC
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:225-869-0389
Mailing Address - Street 1:1732 DEROCHE CIRCLE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052
Mailing Address - Country:US
Mailing Address - Phone:225-869-0389
Mailing Address - Fax:225-869-0271
Practice Address - Street 1:1732 DEROCHE CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052
Practice Address - Country:US
Practice Address - Phone:225-869-0389
Practice Address - Fax:225-869-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C900Medicare ID - Type Unspecified