Individual
MR. DWIGHT A TIETJEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
4801 CRESCENT DR, SHREVEPORT, LA 71106-1807
(318) 464-0553
Mailing address
4801 CRESCENT DR, SHREVEPORT, LA 71106-1807
(318) 464-0553
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT118
LA
Other
Enumeration date
06/19/2007
Last updated
07/08/2007
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