Individual
MIRANDA M WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
403 E FLOURNOY LUCAS RD, SHREVEPORT, LA 71115-3906
(318) 798-3500
Mailing address
21 CEASER CIR, BENTON, LA 71006-1303
(318) 655-6106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05207
LA
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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