Individual
LUCIAN THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
153 CRANDON LN, HAUGHTON, LA 71037-9753
(318) 550-1007
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A10795R
LA
Other
Enumeration date
11/10/2021
Last updated
11/10/2021
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