Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 22734 | LA |
NPI | 1003315607 |
---|---|
Provider Name | Mr. Matthew Alan Armstrong |
First Address | Shreveport, LA 71106-8403 |
Second Address | Shreveport, LA 71118-6114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2018 |
Last Update Date | 08/02/2018 |