Individual
BRYAN JOSEPH COLLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1510 REES ST, BREAUX BRIDGE, LA 70517-4310
(337) 332-2730
(337) 332-2711
Mailing address
1510 REES ST, BREAUX BRIDGE, LA 70517-4310
(337) 332-2730
(337) 332-2711
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
34289
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001848
—
LA
01
—
1353345
TYPE 15 MEDICAID
LA
Enumeration date
02/13/2008
Last updated
04/25/2008
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