# SHREVEPORT AQUATIC AND LAND PHYSICAL THERAPY. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134623457
- **Authorized official:** AARON BLICK (CEO)
- **Authorized official phone:** (214) 295-6703

## Contact information

- **Practice address:** 6969 FERN LOOP, SHREVEPORT, LA 71105-4159
- **Practice address phone:** (214) 295-6703
- **Mailing address:** 6969 FERN LOOP, SHREVEPORT, LA 71105-4159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/21/2018
- **Last updated:** 05/11/2018