Healthcare Provider Details

I. General information

NPI: 1629317417
Provider Name (Legal Business Name): WHITNEY FEDOR BRASWELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 PRYTANIA ST SU 310
NEW ORLEANS LA
70115-3532
US

IV. Provider business mailing address

2701 AIRLINE DR STE L
METAIRIE LA
70001-7213
US

V. Phone/Fax

Practice location:
  • Phone: 504-309-5461
  • Fax: 504-309-5460
Mailing address:
  • Phone: 504-324-8345
  • Fax: 504-734-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH6724
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: