Healthcare Provider Details

I. General information

NPI: 1629291976
Provider Name (Legal Business Name): KEVIN MCBRIDE PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 I 49 S SERVICE RD
OPELOUSAS LA
70570-0757
US

IV. Provider business mailing address

200 KATE RD
CARENCRO LA
70520-6215
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-4212
  • Fax: 337-942-9979
Mailing address:
  • Phone: 337-298-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6584
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: