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General NPI Number Information
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NPI Number | 1134412216
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Entity Type | Organization
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Legal Business Name | PHYSIOFIT DME LLC
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 120 WHITE ROSE DR
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City | RACELAND
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State | LA
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Zip | 70394-2644
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Country | US
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Telephone | 985-532-2229
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Fax | 985-532-2230
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Provider Business Mailing Address
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Address Line | 120 WHITE ROSE DR
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City | RACELAND
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State | LA
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Zip | 70394-2644
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Country | US
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Telephone | 985-532-2229
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Fax | 985-532-2230
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY JOHN BREAUX
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Credential | B.S.
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Telephone | 985-381-3811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 6211
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 6211
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 6211
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License Number State | LA
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