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General NPI Number Information
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NPI Number | 1215353115
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Entity Type | Organization
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Legal Business Name | STUDIO P3, LLC
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Dates
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Enumeration Date | 03/16/2014
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Last Update Date | 03/16/2014
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Provider Practice Location Address
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Address Line | 266 OCKLEY DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-3025
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Country | US
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Telephone | 337-580-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 266 OCKLEY DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-3025
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Country | US
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Telephone | 337-580-0083
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. SUZANNAH YORK-CRUMP
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Credential | PT
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Telephone | 337-580-0083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 07638
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License Number State | LA
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