Individual
MARK KLOCKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1401 ODEN ST UNIT 25, SHREVEPORT, LA 71104-3843
(318) 560-0627
Mailing address
1401 ODEN ST UNIT 25, SHREVEPORT, LA 71104-3843
(318) 560-0627
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A6908
LA
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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