Healthcare Provider Details

I. General information

NPI: 1477461051
Provider Name (Legal Business Name): BRENNAN CHANCE STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 CYPRESS ST
SULPHUR LA
70663-5050
US

IV. Provider business mailing address

522 CYPRESS ST
SULPHUR LA
70663-5050
US

V. Phone/Fax

Practice location:
  • Phone: 337-533-8410
  • Fax: 337-533-8411
Mailing address:
  • Phone: 337-533-8410
  • Fax: 337-533-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12528
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: