Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 08117 | LA |
N | 2251G0304X | Physical Therapist - Geriatrics | 08117 | LA |
NPI | 1316303399 |
---|---|
Provider Name | Dr. Gregory Kyle Kintzing |
First Address | Shreveport, LA 71105-5744 |
Second Address | Shreveport, LA 71105-5744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2016 |
Last Update Date | 07/12/2021 |