Organization
SPORTS ORTHOPEDIC & SPINE THERAPY OF LOUISIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK GREEN PT (OWNER-MANAGER)
(318) 745-9168
Entity
Organization
Contact information
Practice address
169 BENT TREE LOOP, HAUGHTON, LA 71037-9085
(318) 745-9168
Mailing address
169 BENT TREE LOOP, HAUGHTON, LA 71037-9085
(318) 745-9168
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2018
Last updated
11/01/2018
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