Healthcare Provider Details

I. General information

NPI: 1255296687
Provider Name (Legal Business Name): BRITTANY LEBOEUF
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: BRITTANY DOIRON

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST
LAFAYETTE LA
70506-6765
US

IV. Provider business mailing address

210 GREEN RIDGE DR
YOUNGSVILLE LA
70592-5978
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-3201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number303368
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: