Individual
LAURA ELISE BARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT, CLT
Contact information
Practice address
1500 LINE AVE, SUITE 104, SHREVEPORT, LA 71101-4639
(318) 213-3810
Mailing address
202 CHENNAULT AVE, BARKSDALE AFB, LA 71110-2038
(703) 973-7725
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT04527R
LA
Other
Enumeration date
06/10/2013
Last updated
06/10/2013
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