Doctor Name: | DR. BLAISE F. BROUSSARD |
NPI Number: | 1578690913 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T., D.P.T. |
License Number: | 00482 |
Business Practice Address: | 309 S Washington St Deridder, LA - 706344861 |
Business Phone Number: | 3374626097 |
Business Fax Number: | 3374620531 |
Mailing Address: | 309 S Washington St, DERIDDER |
State: | LA |
Postal Code: | 706344861 |
Phone Number: | 3374626097 |
Fax Number: | 3374620531 |
NPI Enumeration Date: | 02/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 00482 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |