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General NPI Number Information
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NPI Number | 1962825331
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Entity Type | Organization
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Legal Business Name | RED RIVER RECOVERY & PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 2539 E. 70TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-364-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 440 MCCORMICK ST
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City | SHREVEPORT
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State | LA
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Zip | 71104-5014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | ELIZABETH M HANSEN
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Credential | PT, DPT
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Telephone | 318-364-7741
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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 | 08371
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License Number State | LA
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