Provider Demographics
NPI:1992945810
Name:ROCKETT, BRIAN DAVID (ATC, LATH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:ROCKETT
Suffix:
Gender:M
Credentials:ATC, LATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9445 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4008
Mailing Address - Country:US
Mailing Address - Phone:985-351-5510
Mailing Address - Fax:
Practice Address - Street 1:9445 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4008
Practice Address - Country:US
Practice Address - Phone:985-351-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2000382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer