Individual
MR. MATTHEW ALAN PENNYWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
L03713
LA
Other
Enumeration date
08/04/2008
Last updated
08/04/2008
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