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General NPI Number Information
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NPI Number | 1629818869
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Entity Type | Individual
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Provider Name | HANNAH ELISE HUCKABEE DPT
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Gender | Female
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 1801 FAIRFIELD AVE STE 103
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City | SHREVEPORT
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State | LA
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Zip | 71101-4457
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Country | US
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Telephone | 318-751-9100
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Fax | 318-751-9101
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Provider Business Mailing Address
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Address Line | 5758 GOLD CREST DR
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City | BOSSIER CITY
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State | LA
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Zip | 71112-8817
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Country | US
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Telephone | 318-402-7102
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Fax |
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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 | 11224
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License Number State | LA
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