Healthcare Provider Details

I. General information

NPI: 1346524758
Provider Name (Legal Business Name): PATRICIA H. HOOPER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 BENT TREE DR
SHREVEPORT LA
71115-9564
US

IV. Provider business mailing address

5500 BENT TREE DR
SHREVEPORT LA
71115-9564
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-9811
  • Fax:
Mailing address:
  • Phone: 318-797-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number00157
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: