# LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
- **Other names:** Allied Health Clinics, Rehab Faculty Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1346609526
- **Legal business name:** LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
- **Authorized official:** REVA MATTHIEW ROBINSON MBA (DIRECTOR OF CLIN MGMT SYSTEM)
- **Authorized official phone:** (318) 813-2962

## Contact information

- **Practice address:** 1450 CLAIBORNE AVE, SHREVEPORT, LA 71103-4204
- **Practice address phone:** (318) 813-2970
- **Practice address fax:** (318) 813-2981
- **Mailing address:** 1501 KINGS HWY, SHREVEPORT, LA 71103-4228
- **Mailing address phone:** (318) 813-2970
- **Mailing address fax:** (318) 813-2981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 2251N0400X | Neurology Physical Therapist | — | NULL | — |
| 2251N0400X | Neurology Physical Therapist | — | — | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |
| 225200000X | Physical Therapy Assistant | — | NULL | — |
| 225200000X | Physical Therapy Assistant | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | NULL | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | — |

## Other

- **Enumeration date:** 02/17/2016
- **Last updated:** 07/31/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1174173 | — | LA |