Healthcare Provider Details

I. General information

NPI: 1841396736
Provider Name (Legal Business Name): ROBERT KEVIN MAYO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3897 SOUTH FIRST STREET P.O. BOX 1816
JENA LA
71342
US

IV. Provider business mailing address

PO BOX 1816
JENA LA
71342-1816
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-1443
  • Fax:
Mailing address:
  • Phone: 318-992-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01246
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: