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General NPI Number Information
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NPI Number | 1629291976
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Entity Type | Individual
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Provider Name | KEVIN MCBRIDE PTA
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 4027 I 49 S SERVICE RD
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City | OPELOUSAS
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State | LA
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Zip | 70570-0757
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Country | US
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Telephone | 337-948-4212
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Fax | 337-942-9979
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Provider Business Mailing Address
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Address Line | 200 KATE RD
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City | CARENCRO
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State | LA
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Zip | 70520-6215
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Country | US
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Telephone | 337-298-8598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A6584
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License Number State | LA
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