Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 06445 | LA |
N | 2251P0200X | Physical Therapist - Pediatrics | 06445 | LA |
NPI | 1063691566 |
---|---|
Provider Name | Mrs. Erica S Brunson |
First Address | Houma, LA 70360-4629 |
Second Address | Morgan City, LA 70380-1893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2007 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306762 | (05) | LA |