Healthcare Provider Details

I. General information

NPI: 1396735825
Provider Name (Legal Business Name): ADAM LAFLEUR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 TIMBER TRAILS RD
BREAUX BRIDGE LA
70517-6544
US

IV. Provider business mailing address

1032 TIMBER TRAILS RD
BREAUX BRIDGE LA
70517-6544
US

V. Phone/Fax

Practice location:
  • Phone: 337-344-0957
  • Fax:
Mailing address:
  • Phone: 337-344-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06409
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: