Healthcare Provider Details

I. General information

NPI: 1568749281
Provider Name (Legal Business Name): BATON ROUGE NEUROLOGICAL TESTING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18291 PIN OAK LN
PRAIRIEVILLE LA
70769-6352
US

IV. Provider business mailing address

18291 PIN OAK LN
PRAIRIEVILLE LA
70769-6352
US

V. Phone/Fax

Practice location:
  • Phone: 225-622-3527
  • Fax: 225-622-3802
Mailing address:
  • Phone: 225-622-3527
  • Fax: 225-622-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE WAYNE BURATT
Title or Position: OWNER/ CEO
Credential: R.EPT.
Phone: 225-622-3527