Organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Active
Parent organization
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Other names
Allied Health Clinics, Rehab Faculty Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
Authorized official
REVA MATTHIEW ROBINSON MBA (DIRECTOR OF CLIN MGMT SYSTEM)
(318) 813-2962
Entity
Organization
Contact information
Practice address
1450 CLAIBORNE AVE, SHREVEPORT, LA 71103-4204
(318) 813-2970
(318) 813-2981
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 813-2970
(318) 813-2981
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251N0400X
Neurology Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174173
—
LA
Enumeration date
02/17/2016
Last updated
07/31/2020
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