Provider Demographics
NPI:1316109374
Name:NORMAND, BRENT WILLIAM (LMT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:WILLIAM
Last Name:NORMAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 BOUTALL ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3546
Mailing Address - Country:US
Mailing Address - Phone:504-421-4399
Mailing Address - Fax:
Practice Address - Street 1:6321 BOUTALL ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-3546
Practice Address - Country:US
Practice Address - Phone:504-421-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3343172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist