Healthcare Provider Details

I. General information

NPI: 1659422913
Provider Name (Legal Business Name): PHILIP RENOUX P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LA RUE FRANCE STE 300
LAFAYETTE LA
70508-3138
US

IV. Provider business mailing address

101 LA RUE FRANCE STE 500
LAFAYETTE LA
70508-3144
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5929
  • Fax: 337-269-5921
Mailing address:
  • Phone: 337-269-9828
  • Fax: 337-234-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00703
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: