Individual
JEREMY STILLWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
217 SAM HOUSTON JONES PKWY, STE 103, LAKE CHARLES, LA 70611-5644
(337) 217-0997
(337) 217-0998
Mailing address
2100 OAK PARK BLVD, LAKE CHARLES, LA 70601-7864
(337) 310-5116
(337) 310-5118
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02441
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548928
—
LA
Enumeration date
02/28/2007
Last updated
09/28/2010
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