Individual
BRENT MICHAEL BURNHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
273 SAWGRASS DR, SHREVEPORT, LA 71106-8413
(318) 464-2288
Mailing address
273 SAWGRASS DR, SHREVEPORT, LA 71106-8413
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08035
LA
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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