Provider Demographics
NPI:1073595922
Name:COCHRAN, BRIAN CARSON (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CARSON
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CORPORATE DR.
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1057
Mailing Address - Country:US
Mailing Address - Phone:985-249-6111
Mailing Address - Fax:985-249-6109
Practice Address - Street 1:129 CORPORATE DR.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1057
Practice Address - Country:US
Practice Address - Phone:985-249-6111
Practice Address - Fax:985-249-6109
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H482Medicare ID - Type Unspecified