MEDICARE: MRS. ERICA S BRUNSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	06445	LA
2	2251P0200X	Pediatric Physical Therapist	06445	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063691566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICA S BRUNSON PT

Provider Business Mailing Address
First Line	:	1001 SCHOOL ST
Second Line	:
City	:	HOUMA
State	:	LA
Zip	:	70360-4629
Country	:	US
Telephone Number	:	985-868-1540
Fax Number	:	985-876-0759

Provider Business Practice Location Address
First Line	:	1340 ELM ST STE 200
Second Line	:
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1893
Country	:	US
Telephone Number	:	985-868-1540
Fax Number	:	985-876-0759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	07/23/2021

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