Individual
MR. JACOB PAUL BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
808 S BROADWAY ST, ERATH, LA 70533-4014
(337) 937-8451
Mailing address
408 PEAR TREE CIR, BROUSSARD, LA 70518-7237
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.200192
LA
Other
Enumeration date
06/01/2020
Last updated
06/01/2020
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