Active NPI
Brett Michael Domangue
- Physical Therapist
- Hammond, LA
National Provider Identifier
1568698181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 02354
- Practice address
- 620 N Morrison Blvd
Suite G
Hammond, LA 70401-2312 - Phone
- (985) 543-4113
- Fax
- (985) 543-4109
- NPI assigned
- Jun 10, 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 02354 | LA | Primary |
Addresses
Primary practice location
620 N Morrison Blvd
Suite G
Hammond, LA 70401-2312
Mailing address
620 N Morrison Blvd
Suite G
Hammond, LA 70401-2312
Phone (985) 543-4113
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 |
|---|---|---|---|
| 02354 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359417600000",
"number": "1568698181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 N MORRISON BLVD",
"address_2": "SUITE G",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704012312",
"telephone_number": "985-543-4113",
"fax_number": "985-543-4109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 N MORRISON BLVD",
"address_2": "SUITE G",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704012312",
"telephone_number": "985-543-4113",
"fax_number": "985-543-4109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMANGUE",
"first_name": "BRETT",
"middle_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-10",
"last_updated": "2013-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "02354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hammond, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.