Healthcare Provider Details

I. General information

NPI: 1710928635
Provider Name (Legal Business Name): JOHN PATRICK BRUMFIELD P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9609 PLANK RD SUITE P
CLINTON LA
70722-3702
US

IV. Provider business mailing address

10742 OAKLINE DR
BATON ROUGE LA
70809-3317
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-1111
  • Fax: 225-683-1177
Mailing address:
  • Phone: 225-683-1111
  • Fax: 225-683-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02247
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: