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General NPI Number Information
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NPI Number | 1811133093
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Entity Type | Organization
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Legal Business Name | BAYOU STATE THERAPY
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 457 ASHLEY RIDGE BLVD STE B
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City | SHREVEPORT
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State | LA
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Zip | 71106-7229
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Country | US
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Telephone | 318-219-7737
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Fax | 318-219-7739
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Provider Business Mailing Address
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Address Line | 457 ASHLEY RIDGE BLVD STE B
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City | SHREVEPORT
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State | LA
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Zip | 71106-7229
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Country | US
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Telephone | 318-219-7737
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Fax | 318-219-7739
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Authorized Official
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Title or Position | PT/OWNER
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Name | KEVIN T SOWELL
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Credential | PT
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Telephone | 318-219-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 03183
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License Number State | LA
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