Active NPI
Bradley James Reaux, LAT, ATC, ITAT, CAFS
- Athletic Trainer
- New Iberia, LA
National Provider Identifier
1356974927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 306607
- Practice address
- 1307 Old Jeanerette Rd Ste 102
New Iberia, LA 70563-5801 - Phone
- (337) 552-5668
- NPI assigned
- Feb 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 306607 | LA | Primary |
Addresses
Primary practice location
1307 Old Jeanerette Rd Ste 102
New Iberia, LA 70563-5801
Mailing address
111 Dijon Dr
Lafayette, LA 70506-5101
Phone (337) 552-5668
Other practice location 1
111 Dijon Dr
Lafayette, LA 70506-5101
Phone (337) 552-5668
Other practice location 2
2402 N Parkerson Ave
Crowley, LA 70526-2015
Phone (337) 552-5668
Other practice location 3
456 S 5th St
Iota, LA 70543-6024
Phone (337) 552-5668
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 306607 | LA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582243200000",
"number": "1356974927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 DIJON DR",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705065101",
"telephone_number": "337-552-5668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1307 OLD JEANERETTE RD STE 102",
"city": "NEW IBERIA",
"state": "LA",
"postal_code": "705635801",
"telephone_number": "337-552-5668"
}
],
"practiceLocations": [
{
"address_1": "111 Dijon Dr",
"address_purpose": "LOCATION",
"city": "Lafayette",
"state": "LA",
"postal_code": "705065101",
"country_code": "US",
"telephone_number": "337-552-5668",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2402 N Parkerson Ave",
"address_purpose": "LOCATION",
"city": "Crowley",
"state": "LA",
"postal_code": "705262015",
"country_code": "US",
"telephone_number": "337-552-5668",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "456 S 5th St",
"address_purpose": "LOCATION",
"city": "Iota",
"state": "LA",
"postal_code": "705436024",
"country_code": "US",
"telephone_number": "337-552-5668",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REAUX",
"first_name": "BRADLEY",
"middle_name": "JAMES",
"credential": "LAT, ATC, ITAT, CAFS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-21",
"last_updated": "2020-02-21",
"certification_date": "2020-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "LA",
"license": "306607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Iberia, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.