| Organization Name: | PHYSIOFIT DME LLC |
| NPI Number: | 1134412216 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEREMY JOHN BREAUX (OWNER) |
| Mailing Address: | 4313 Highway 1 Ste B Raceland |
| State: | LA US |
| Postal Code: | 703943876 |
| Phone Number: | 9853813811 |
| Fax Number: | 9855323942 |
| NPI Enumeration Date: | 05/23/2011 |
| NPI Last Update Date: | 11/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | 6211 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |