Healthcare Provider Details

I. General information

NPI: 1073844486
Provider Name (Legal Business Name): FUNCTIONAL CAPACITY EXPERTS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 JIMMIE DAVIS HWY SUITE 400
BOSSIER CITY LA
71112-4557
US

IV. Provider business mailing address

1613 JIMMIE DAVIS HWY SUITE 400
BOSSIER CITY LA
71112-4557
US

V. Phone/Fax

Practice location:
  • Phone: 318-658-5800
  • Fax:
Mailing address:
  • Phone: 318-658-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number01827
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number01827
License Number StateLA

VIII. Authorized Official

Name: DR. STEVE V ALLISON
Title or Position: PRESIDENT
Credential: D.P.T.
Phone: 318-658-5800