MEDICARE: RENE MICHAEL LEBLANC PT, MPT

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	04425	LA

General Provider Information

NPI Number	:	1962567875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE MICHAEL LEBLANC PT, MPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	484 ALBERTSON PKWY STE A
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-4968
Country	:	US
Telephone Number	:	337-839-8883
Fax Number	:	337-398-8939

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	09/20/2022

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