Provider Demographics
NPI:1063691566
Name:BRUNSON, ERICA S (PT)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:S
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4629
Mailing Address - Country:US
Mailing Address - Phone:985-868-1540
Mailing Address - Fax:985-876-0759
Practice Address - Street 1:1340 ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1893
Practice Address - Country:US
Practice Address - Phone:985-868-1540
Practice Address - Fax:985-876-0759
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06445225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306762Medicaid