Individual
DANIEL TUBONGBANUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
1691 BIENVILLE DR, MONROE, LA 71201-3756
(318) 998-7805
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1082147
TX
Other
Enumeration date
05/10/2022
Last updated
05/17/2024
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