Individual
JOHN BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 N MORRISON BLVD STE G, HAMMOND, LA 70401-2312
(985) 543-4113
Mailing address
620 N MORRISON BLVD STE G, HAMMOND, LA 70401-2312
(985) 543-4113
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1218
LA
2251H1300X
Human Factors Physical Therapist
01218
LA
Other
Enumeration date
06/08/2009
Last updated
12/06/2011
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