# NORTHWEST LOUISIANA PHYSICAL MEDICINE

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

## Provider details

- **NPI number:** 1720071590
- **Authorized official:** JENNESS COURTNEY MD (PRESIDENT)
- **Authorized official phone:** (318) 424-4224

## Contact information

- **Practice address:** 9045 ELLERBE RD STE 107, SHREVEPORT, LA 71106-6799
- **Practice address phone:** (318) 424-4224
- **Practice address fax:** (318) 865-5330
- **Mailing address:** 1801 FAIRFIELD AVE, STE 411, SHREVEPORT, LA 71101-4443
- **Mailing address phone:** (318) 424-4224
- **Mailing address fax:** (318) 424-4044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | LA | Yes |

## Other

- **Enumeration date:** 08/26/2005
- **Last updated:** 08/21/2024