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General NPI Number Information
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NPI Number | 1982203840
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Entity Type | Individual
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Provider Name | KERVINS DELPHONSE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 663 JORDAN ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4748
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Country | US
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Telephone | 318-222-8882
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Fax | 318-222-8893
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Provider Business Mailing Address
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Address Line | 10 OAK CT APT 5211
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City | HOUSTON
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State | TX
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Zip | 77006-1666
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Country | US
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Telephone | 786-547-7237
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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 | 11746R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT36227
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1384870
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License Number State | TX
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