Organization
LINCOLN OUTPATIENT THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW RANDOLPH SHIRLEY PT (PRESIDENT)
(318) 255-9601
Entity
Organization
Contact information
Practice address
1817 NORTHPOINTE LANE, RUSTON, LA 71270-3879
(318) 255-9601
(318) 255-7971
Mailing address
PO BOX 1306, RUSTON, LA 71273-1306
(318) 255-9601
(318) 255-7971
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1169234
—
AL
01
—
7822443
AETNA
LA
Enumeration date
03/16/2006
Last updated
12/15/2011
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