Individual
BRANDON JOSEPH BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
208 W MCNEESE ST, LAKE CHARLES, LA 70605-5638
(337) 475-1053
Mailing address
1322 ELTON RD STE I, JENNINGS, LA 70546-4100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10612
LA
Other
Enumeration date
06/12/2020
Last updated
06/12/2020
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