Healthcare Provider Details

I. General information

NPI: 1386944718
Provider Name (Legal Business Name): DEBORAH BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SAMFORD AVE
SHREVEPORT LA
71103-4239
US

IV. Provider business mailing address

3100 SAMFORD AVE
SHREVEPORT LA
71103-4239
US

V. Phone/Fax

Practice location:
  • Phone: 318-226-3329
  • Fax: 318-424-7610
Mailing address:
  • Phone: 318-226-3329
  • Fax: 318-424-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number00651
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: