| Doctor Name: | BRYAN JOSEPH COLLETTE |
| NPI Number: | 1396913224 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 34289 |
| Business Practice Address: | 1510 Rees St Breaux Bridge, LA - 705174310 |
| Business Phone Number: | 3373322730 |
| Business Fax Number: | 3373322711 |
| Mailing Address: | 1510 Rees St, BREAUX BRIDGE |
| State: | LA |
| Postal Code: | 705174310 |
| Phone Number: | 3373322730 |
| Fax Number: | 3373322711 |
| NPI Enumeration Date: | 02/13/2008 |
| NPI Last Update Date: | 04/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | 34289 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |