Healthcare Provider Details

I. General information

NPI: 1801819768
Provider Name (Legal Business Name): PAULA FENTER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONS
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1450 CLAIBORNE AVE LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONS
SHREVEPORT LA
71103-4204
US

V. Phone/Fax

Practice location:
  • Phone: 318-813-2962
  • Fax: 318-813-2975
Mailing address:
  • Phone: 318-813-2970
  • Fax: 318-813-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: