Provider Demographics
NPI:1104070192
Name:AUSTIN-BRAUD, AMINA LOSSHONDRA (PT)
Entity type:Individual
Prefix:
First Name:AMINA
Middle Name:LOSSHONDRA
Last Name:AUSTIN-BRAUD
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 1:616 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7344
Mailing Address - Country:US
Mailing Address - Phone:337-232-1763
Mailing Address - Fax:
Practice Address - Street 1:616 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7344
Practice Address - Country:US
Practice Address - Phone:337-232-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist