Individual
LOUIS JOHN FAVORITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
(940) 322-0771
(940) 766-4943
Mailing address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
(940) 322-0771
(940) 766-4943
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2088720
TX
225200000X
Physical Therapy Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111408402
—
TX
Enumeration date
07/06/2012
Last updated
07/06/2012
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