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General NPI Number Information
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NPI Number | 1619928322
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Entity Type | Individual
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Provider Name | SHERALYN KING CALLIHAN-FAVROT P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 309 S VAUGHN DR STE F
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City | BRUSLY
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State | LA
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Zip | 70719-2593
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Country | US
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Telephone | 225-749-2065
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Fax | 225-749-2427
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Provider Business Mailing Address
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Address Line | 7523 HIGHWAY 1 S
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City | ADDIS
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State | LA
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Zip | 70710-2148
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Country | US
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Telephone | 225-687-0602
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Fax | 225-687-0610
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 01005
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License Number State | LA
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