Individual
LOIS RAYNER MABERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1500 LINE AVE, SHREVEPORT, LA 71101-4639
(318) 213-3800
Mailing address
137 PROMENADE AVE, SHREVEPORT, LA 71115-3241
(318) 286-5414
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1103R
LA
Other
Enumeration date
02/15/2007
Last updated
09/07/2011
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