Provider Demographics
NPI:1952349482
Name:ENLOW, BRIAN T (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:ENLOW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2224
Mailing Address - Country:US
Mailing Address - Phone:318-367-0604
Mailing Address - Fax:318-367-2678
Practice Address - Street 1:3630 FRONT ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2224
Practice Address - Country:US
Practice Address - Phone:318-367-0604
Practice Address - Fax:318-367-2678
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA3556225200000X
LA07456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty