Provider Demographics
NPI:1144527375
Name:BREAUX, KAREN C (LPTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:BREAUX
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:KC
Other - Middle Name:
Other - Last Name:BREAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:154 LOWERY RD
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-8473
Mailing Address - Country:US
Mailing Address - Phone:662-871-4416
Mailing Address - Fax:
Practice Address - Street 1:200 LONG ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-4306
Practice Address - Country:US
Practice Address - Phone:662-728-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4749225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant