Healthcare Provider Details

I. General information

NPI: 1427190149
Provider Name (Legal Business Name): SHREVEPROT DOCTORS REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BUCKNER ST SUITE A-206
SHREVEPORT LA
71101-4440
US

IV. Provider business mailing address

1800 BUCKNER ST SUITE A-206
SHREVEPORT LA
71101-4440
US

V. Phone/Fax

Practice location:
  • Phone: 318-678-8801
  • Fax: 318-678-8807
Mailing address:
  • Phone: 318-678-8801
  • Fax: 318-678-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT G HARVEY JR.
Title or Position: PRESIDENT
Credential:
Phone: 504-821-2574