Healthcare Provider Details

I. General information

NPI: 1639317704
Provider Name (Legal Business Name): LATONYA P MISTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 SWAN LAKE RD STE E
BOSSIER CITY LA
71111-5366
US

IV. Provider business mailing address

2008 AIRLINE DR STE 300-288
BOSSIER CITY LA
71111-2946
US

V. Phone/Fax

Practice location:
  • Phone: 318-553-5022
  • Fax: 318-594-3088
Mailing address:
  • Phone: 601-405-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4653
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009525
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10520R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: