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General NPI Number Information
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NPI Number | 1720839491
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Entity Type | Individual
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Provider Name | ROBYN SLAGLE PTA
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Gender | Female
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 6969 FERN LOOP STE A
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City | SHREVEPORT
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State | LA
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Zip | 71105-4159
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Country | US
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Telephone | 318-383-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 428 S NATCHITOCHES ST
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City | SIBLEY
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State | LA
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Zip | 71073-2912
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Country | US
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Telephone | 509-942-4369
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A09809R
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License Number State | LA
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