Healthcare Provider Details

I. General information

NPI: 1710947304
Provider Name (Legal Business Name): FRANKLIN PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 B ENERGY PKWY
LAFAYETTE LA
70508
US

IV. Provider business mailing address

101 B ENERGY PKWY
LAFAYETTE LA
70508
US

V. Phone/Fax

Practice location:
  • Phone: 337-264-9363
  • Fax: 337-234-0310
Mailing address:
  • Phone: 337-264-9363
  • Fax: 337-234-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL07234R
License Number StateLA

VIII. Authorized Official

Name: MRS. KELLY C VACCARELLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-264-9363