Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1255840484 |
---|---|
Provider Name | Mrs. Armafe Teresita Veneracion |
First Address | Shreveport, LA 71115-9304 |
Second Address | Shreveport, LA 71115-9304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2017 |
Last Update Date | 16/06/2018 |