Active NPI
Brad Michael Penouilh Jr., MA, ATC, LAT
- Athletic Trainer
- Westwego, LA
National Provider Identifier
1225073059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 710 West Dr
Westwego, LA 70094-4736 - Phone
- (504) 810-9111
- NPI assigned
- Jun 17, 2006
- Last updated
- Feb 26, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | NU | Primary |
Addresses
Primary practice location
710 West Dr
Westwego, LA 70094-4736
Mailing address
710 West Dr
Westwego, LA 70094-4736
Phone (504) 810-9111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235606400000",
"number": "1225073059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 WEST DR",
"city": "WESTWEGO",
"state": "LA",
"postal_code": "700944736",
"telephone_number": "504-810-9111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 WEST DR",
"city": "WESTWEGO",
"state": "LA",
"postal_code": "700944736",
"telephone_number": "504-810-9111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENOUILH",
"first_name": "BRAD",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MA, ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2009-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westwego, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.