Provider Demographics
NPI:1871744979
Name:BRASSEAUX, RICHARD A (MPT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BRASSEAUX
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786-0392
Mailing Address - Country:US
Mailing Address - Phone:225-275-9293
Mailing Address - Fax:225-275-7671
Practice Address - Street 1:17544 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4014
Practice Address - Country:US
Practice Address - Phone:225-275-9293
Practice Address - Fax:225-275-7671
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06982R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist