Individual
TONGALA RENEE JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1257 N PINES DR, SHREVEPORT, LA 71107-2723
(318) 678-0656
Mailing address
1257 N PINES DR, SHREVEPORT, LA 71107-2723
(318) 678-0656
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2065062
TX
225200000X
Physical Therapy Assistant
Primary
A4521
LA
Other
Enumeration date
04/02/2008
Last updated
10/22/2020
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