Individual
TONYA L MCCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, CWS
Contact information
Practice address
1500 LINE AVE, SHREVEPORT, LA 71101-4639
(318) 213-3800
(318) 213-3763
Mailing address
1500 LINE AVE, SHREVEPORT, LA 71101-4639
(318) 213-3800
(318) 213-3763
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
04704
LA
Other
Enumeration date
06/10/2006
Last updated
06/07/2011
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