Organization
PEDIATRIC THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEY DEBEVEC LOTR (EXECUTIVE DIRECTOR)
(318) 448-3848
Entity
Organization
Contact information
Practice address
1300 JACKSON ST, ALEXANDRIA, LA 71301-6929
(318) 448-3848
(318) 448-3953
Mailing address
1300 JACKSON ST, ALEXANDRIA, LA 71301-6929
(318) 448-3848
(318) 448-3953
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1462195
—
LA
05
—
1698202
—
LA
Enumeration date
01/28/2006
Last updated
08/22/2020
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