Healthcare Provider Details

I. General information

NPI: 1225559263
Provider Name (Legal Business Name): SUSAN ANDERSON ROBLOW PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 UNADILLA STREET
SHREVEPORT LA
71106
US

IV. Provider business mailing address

921 UNADILLA ST
SHREVEPORT LA
71106-1137
US

V. Phone/Fax

Practice location:
  • Phone: 318-272-1515
  • Fax:
Mailing address:
  • Phone: 318-272-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1942
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: