MEDICARE: MRS. DENISE MARIE BRASSEAUX 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	00989	LA

General Provider Information

NPI Number	:	1396174173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE MARIE BRASSEAUX PT

Provider Business Mailing Address
First Line	:	5423 HIDDEN RIDGE LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6359
Country	:	US
Telephone Number	:	225-772-3527
Fax Number	:

Provider Business Practice Location Address
First Line	:	5423 HIDDEN RIDGE LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6359
Country	:	US
Telephone Number	:	225-772-3527
Fax Number	:

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

Provider Enumeration Date	:	11/02/2013
Last Update Date	:	11/02/2013

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