Healthcare Provider Details

I. General information

NPI: 1184775603
Provider Name (Legal Business Name): CHANTEL BRIGNAC P.T., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 DEROCHE CIRCLE SUITE B
GRAMERCY LA
70052-5639
US

IV. Provider business mailing address

1732 DEROCHE CIRCLE SUITE B
GRAMERCY LA
70052-5639
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-0389
  • Fax: 225-869-0271
Mailing address:
  • Phone: 225-869-0389
  • Fax: 225-869-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01899
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: