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NPI Code Detail

MEDICARE: ROBYN BRULATOUR PT

MEDICARE: ROBYN BRULATOUR PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT4320MS

General Provider Information

NPI Number : 1962640292
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBYN BRULATOUR PT
Provider Business Mailing Address
First Line : 1615 19TH AVE
Second Line :
City : GULFPORT
State : MS
Zip : 39501-2127
Country : US
Telephone Number : 901-337-3744
Fax Number :
Provider Business Practice Location Address
First Line : 2279 ATKINSON RD
Second Line :
City : BILOXI
State : MS
Zip : 39531-2209
Country : US
Telephone Number : 228-388-1805
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2009
Last Update Date : 06/21/2016

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