Individual
MATTHEW DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
650 OLIVE ST, SHREVEPORT, LA 71104-2210
(318) 302-6000
Mailing address
4702 ERIN LN, SHREVEPORT, LA 71109-6215
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A9209
LA
Other
Enumeration date
01/03/2020
Last updated
01/03/2020
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