Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 04453 | LA |
N | 2251G0304X | Physical Therapist - Geriatrics | 04453 | LA |
N | 2251X0800X | Physical Therapist - Orthopedic | 04453 | LA |
NPI | 1336575299 |
---|---|
Provider Name | Ms. Celeste Marie Broussard |
First Address | New Orleans, LA 70115-3431 |
Second Address | New Orleans, LA 70124-2745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |